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HE STANDARD 
ILY PHYSICIAN 


VOLUME I 




THE STANDARD 
FAMILY PHYSICIAN 


A Practical International Encyclopedia of 
Medicine and Hygiene Especially 
Prepared for the Household 


BY 

PROF. CARL REISSIG, M.D., 

\\ 

of Hamburg, Germany 
AND 

SMITH ELY JELLIFFE, A.M., M.D., Ph.D., 

Professor of Pharmacognosy, Pharmaceutical Department, Columbia University; 
Instructor in Pharmacology and Therapeutics, Medical Department, 
Columbia University; Visiting Neurologist, City Hospital, 

New York; Associate Editor, New York Medical 
Journal ; Managing Editor, Journal of 
Nervous and Mental Disease 


With the Assistance of Many American and German Specialists in the 
Treatment of Diseases and Experts in Medicine 

and Surgery 


VOLUME I—A to L 



FUNK & WAGNALLS COMPANY 

NEW YORK AND LONDON 

1 9°7 






“KG & 

."R4- 


LIBRARY of CONGRESS 
Two OotHes Received 

APK 19 1907 


v. topyrtfht Entry 
CLASS yA KXc„ No. 



Copyright 1907, by 

FUNK & WAGNALLS COMPANY 
New York 


[Printed in the United States of America] 




66 The able physician, before he attempts to give medi¬ 
cine to his patient, 'makes himself acquainted not only 

l ,* 

with the disease which he wishes to cure, but with the 
habits and constitution of the sick man." 

—CICERO 

“ JBetter is the poor, being sound and strong of consti¬ 
tution, than the rich man that is afflicted in his body; 
health and a good state of body are above all gold, and a 
strong body above infinite wealth; there are no riches 
above a sound body, and no joy above that of health." 

—SlRACH 

“Nothing is more estimable than a physician who, 
having studied nature from his youth, knows the proper¬ 
ties of the human body, the diseases which assail it, the 
remedies which will benefit it, exercises his art with cau¬ 
tion, and pays equal attention to the rich and the poor." 


—VOLTAIRE 


FOREIGN EDITORIAL STAFF 


EDITOR-IN-CHIEF 


PROF. 


CARL REISSIG, M.D., 

of Hamburg, Germany 


ASSOCIATE EDITORS 


Dr. Abel (Berlin), 

State and Medical Councilor; Member of the 
Government Board of Health. 
Illumination; Cholera; Heating; Domicile. 

Dr. A. Albu (Berlin), 

Lecturer in Medicine. 

Diseases of the Stomach and Intestines; 
Vegeta rianism. 

Dr. G. Avellis (Frankfort-on-the-Main), 
Diseases of the Throat , Nose , and Ear. 

Dr. K. Beerwald (Berlin), 

Nutrition , Diet, and Exercise. 

Dr. G. Broesike (Berlin), 

Assistant Professor in Anatomy. 
Structure and Functions of the Healthy 
Human Body. 

Dr. H. Buchbinder (Leipsic), 

Surgery. 

Prof. Dr. A. Duhrssen (Berlin), 
Gynecology. 

Dr. F. Gernsheim (Worms), 

Diseases of Children; Nursing and Care of 
Babies and Children. 

Dr. Gersuny (Vienna), 

Member of the Government Board of Health. 

Dr. K. Gutzmann (Berlin), 
Impediment of Speech. 

Dr. H. Hughes (Soden), 

Gymnastics and Exercises 

Dr. E. Jaeger (Leipsic), 

Gymnastics and Exercise. 

Dr. H. Kantor (Warnsdorf), 

Chief Physician. 

Nursing. 

Dr. G. (Celling (Dresden), 

General Doctrine of Disease. 

Prof. Dr. A. Kolliker (Leipsic), 

Surgery. 

Prof. Dr. Kopp (Munich), 

Diseases of the Sexual Organs. 

Dr. E. Kunstmann (Dresden), 

Dentist. 

Care of the Teeth. 


Dr. Naegeli (Ermatingen), 

Treatment of Diseases by Massage. 

Dr. Neumann (Bromberg), 
Surgeon-Major. 

Condition op the Body for Military Service; First 
Aid to Injured. 

Prof. Dr. von Noorden (Frankfort-on-the-Main), 

Obesity and Diabetes. 

Dr. H. Paschkis (Vienna), 

Lecturer in Medicine. 

Home Medicines; Skin Diseases. 

Prof. Dr. F. Rosenbach (Berlin), 

Chlorosis; Anemia. 

Dr. O. Schaffer (Heidelberg), 

Lecturer in Medicine. 

Childbirth; Pregnancy; Nursing; Childbed. 

Dr. B. Scheube (Greiz), 

Member of the Government Board of Health. 
Hygiene and Diseases of the Tropics. 

Prof. Dr. K. Schleich (Berlin), 

Chloroform; Anesthesia; Care of the Hair , Skin, 
and Nails. 

Dr. L. Scholz (Waldbrol), 

Director. 

Mental Diseases. 

Prof. Dr. P. Silex (Berlin), 

Diseases of the Eye. 

Prof. Dr. Th. Sommerfeld (Berlin), 

Diseases Originating from Vocation; Diseases 
of the Lungs; First Aid. 

Dr. O. Spitta (Berlin), 

Dress; School. 

Dr. Thoma (Hamburg), 

Seasickness. 

Dr. L. Voigt (Hamburg), 

Smallpox; Vaccination. 

Dr. Walko (Prague), 

Diseases of the Heart and Kidneys; Infectious 
Diseases. 

Dr. R. Wichmann (Harzburg), 

Chief Health Officer. 

Diseases of the Nerves; The Use of Water , 
Light , and Air; Sexual Intercourse, 





AMERICAN EDITORIAL STAFF 

EDITOR-IN-CHIEF 

SMITH ELY JELLIFFE, A.M., M.D., Ph.D., 

Professor of Pharmacognosy, Pharmaceutical Department, Columbia University; 
Instructor in Pharmacology and Therapeutics, Medical Department, 
Columbia University ; Visiting Neurologist, City Hospital, 

New York ; Associate Editor, New York Medical 
Journal ; Managing Editor, Journal of 
Nervous and Mental Disease 


ASSOCIATE EDITORS 

FRANK E. MILLER, M.D., 

Consulting Laryngologist, St. Joseph’s Hospital and the Metropolitan College of Music; 
Member of the American Laryn go logical and Rhinological Association, New York 
City. 

ISADORE DYER, M.D., 

Lecturer and Clinical Instructor in Dermatology, Medical Department of Tulane Univeu 
sity; Dermatologist to the Charity Hospital; Consulting Dermatologist to Ear, 
Nose, and Throat Hospital; Professor of Diseases of the Skin, New Orleans 
Polyclinic; Member of American Dermatological Association. 

GLENTWORTH R. BUTLER, M.D., 

Attending Physician, Methodist Episcopal Hospital; Author of “ Diagnostics of Internal 
Medicine,” Brooklyn, N. Y. 

DOUGLAS W. MONTGOMERY, M.D., 

Professor of Diseases of the Skin in the Medical Department, University of California, 
Berkeley, Cal. 

H. V. WURDEMANN, M.D., 

Professor of Ophthalmology and Otology, Milwaukee Medical College; Chief of Eye 
Clinic; Ophthalmic and Aural Surgeon, Trinity Hospital, Milwaukee County 
Hospital, Children’s Hospital, and Milwaukee County Hospital for the Insane, 
Milwaukee, Wis. 

WILLIAM A. WHITE, M.D., 

Superintendent, Government Hospital for the Insane, Washington, D. C.; Professor of 
Nervous and Mental Diseases, Georgetown University, Washington, D. C.; Pro¬ 
fessor and Clinical Professor of Mental Diseases, George Washington University, 
Washington, D. C. 

CHARLES F. WINGATE, Sanitary Engineer, 

New York City 

GEORGE STERLING RYERSON, M.D., L.R.C.S., Edin., 

Professor of Ophthalmology and Otology in the Medical Faculty, University of Toronto, 
Canada; Colonel, Canadian Army Medical Corps. 

HILLS COLE, M.D., 

Managing Editor, North American Journal of Homoeopathy; Medical Expert and Chief of 
the Division of Publicity and Education of the New York State Department of 
Health; Chairman of the Committee on Public Health of the Homoeopathic Medical 
Society of the County of New York; Member of the American Institute for Scien¬ 
tific Research. 

GEORGE RYERSON FOWLER, M.D., 

(DECEASED ) 

Late Professor of Surgery, New York Polyclinic; Examiner in Surgery, New York 
State Board of Medical Examiners. 








































































» 
























































' 









































































CONTENTS 


(Note: To facilitate reference, it should be borne in mind that volume I comprises 

pages 1-530; volume II, pages 531-1061.) 


Preface 


PAGE 

xxix. 


The Family Physician 


xxxiii. 


Structure and Functions of the Healthy Human Body 

I. Introduction. 1 

II. Chief Constituents of the Human Body. 2-5 

Structure (2-3), Shape (3-4), and Activity (4-5) of Cells. 

III. Tissues of the Human Body. 5-18 

Epithelial tissue (5-6); Connective tissue (6-10); Muscle 

(10-12); Nerve-tissue (12-15); Blood and Lymph (15-18). 

IV. The Human Skin.18-23 

V. Gross Anatomy of the Human Body.23-28 

External shape (23); Internal structure (23-25); Terms 

used in describing separate organs (25-28). 


VI. Bones.28-38 

Skull (29-30); Vertebral Column (30-32); Thorax (32-33); 

Upper extremities (33-35); Lower extremities (35-38). 

VII. Joints and Ligaments.38-41 

Motions of joints (38-39); Temporo-maxillary joint (39); 


Joints of the vertebrae (39); Articulations of the ribs (39- 
40); Joints of the upper extremities (40-41); Joints of 
the lower extremities (41). 

VIII. Muscles.42-47 

Form of muscles (42); Functional capacity (43); Muscles 
of the head (44); Muscles of the back (44); Muscles of 
the neck (44); Muscles of the chest (44-45); Muscles of 
the abdomen (45).; Muscles of the upper extremities (45-46); 

Muscles of the lower extremities (46-47). 

IX. Internal Organs.47-59 

1. Organs of Respiration: Nasal fossae (47-49); Pharynx 
(49); Larynx (49-50); Trachea (50-51); Thyroid gland 
(51); L ungs (51-52). 2. Organs of Digestion: Mouth 

(53-55); Pharynx (55); Esophagus (56); Stomach (56); 
Intestinal tract (56-57); Liver (58); Pancreas (58); Spleen 
(58). 3. Urinary Organs: Kidneys (59); Ureters (59); 

Bladder (59). 


IX 











CONTENTS 


PAGE 


X. Circulatory System.60-65 

Heart (60-62); Current of blood (61); Pericardium (61); 

Arteries (62-63 N Veins (63-64); Process of circulation 
(64-65). 

XI. Nervous System.65-68 

1. Central Organs: Brain (65-66); Spinal cord (66). 2. 

Peripheral Nerves: Cerebral nerves (66-67); Spinal nerves 
(67). 3. Sympathetic Nerve , and its branches (67-68). 

XII. Organs of Special Sense.68-72 

1. The Eye: Motor apparatus (68); Protective organs (68- 
69); Eyeball (69-70); Refracting portions (70); Per¬ 
ception of light (70). 2. The Ear: External ear (71); 

Middle ear (71); Internal ear (71-72); Perception of 
sound (72). 

XIII. Organs of Generation.72-77 

Male organs (72-74); External female organs (73-75); In¬ 
ternal female organs (75-77). 

General Remarks on Disease 

I. Nature of Disease .78-81 

II. Causes of Disease.81-85 

III. Origin of Disease.85-87 

IV. Course of Disease.87-89 

V. Termination of Disease .89-91 

Diagnosis and Treatment of Disease 

I. Diagnosis of Disease.92-95 

II. Treatment of Disease.95-97 


Pathology—Hygiene—Materia Medica 
{For complete list oj topics treated in this part oj the work , see the index.) 

Bacteria—Insects—Parasites—Parasitic Diseases.—Anthrax (136) ; Bac¬ 
teria (157); Filaria (344); Harvest-Tick (407); Insect Stings and 
Bites (474); Lice (507); Parasites (680); Sand-Flea (745); Scabies 
(761); Tapeworm (848); Trichinosis (873); Wood-Tick (946); 
Worms (946). 

Baths—Cures—Massage.—Air-Bath (104); Baths and Bathing (162); 
Bran-Bath (195); Climate and Disease (233); Electricity, Thera¬ 
peutic Application of (239); Fango (339); Grape-Cure (371); Hard¬ 
ening (405); Herb-Bath (433); Hot-Air Bath (443); Light-Bath, 
















CONTENTS 


xi 


Electric (511); Light-Treatment (513); Massage (535); Mineral 
Waters (573); Mud-Bath (584); Mustard-Bath (589); Packs (656); 
Pine-Needle Bath (697); Poultices (708); Salt-Water Bath, Arti¬ 
ficial (744); Sand-Bath (744); Sea-Bath (771); Shower-Bath (781); 
Springs, Mineral (818); Steam-Bath (823); Sulfur-Bath, Artificial 
(841); Sun-Bath (842), Swimming (843); Water-Treatment (932). 

Care of Infants and Children.—Ear, Care of (289); Eye, Care of (323); 
Hardening (405); Health-Care of Children (410); Incubation Periods 
(460); Masturbation (542); Nursing (613); Nursling, Care of (616); 
Nursling, Nourishing of (627); School (765); Skin, Care of (793); 
Teeth, Care of (854); Voice and Speech (927). 

Children’s Diseases.—Balanitis (158); Chicken-Pox (219); Cholera In¬ 
fantum (229); Cretinism (S68); Diphtheria (263); Eclampsia, In¬ 
fantile (296); Enuresis (305); German Measles (360); Hip-Joint, 
Congenital Dislocation of (435); Measles (543); Mouth-Diseases of 
Children (583); Mumps (584); Navel Diseases (595); Rickets (735); 
Scrofula (768); Whooping-Cough (936). 

Constitutional Diseases.—Anemia (121); Brain, Softening of (194); Cre¬ 
tinism (868); Diabetes (258); Elephantiasis (300); Epilepsy (307); 
Exophthalmic Goiter (321); Gout (369); Hemophilia (424); Hypo¬ 
chondria (449); Leprosy (506); Muscular Atrophy (586); Myxedema 
(868); Obesity (634); Rickets (735); Scrofula (768); Scurvy (770); 
Syphilis (919); Tabes Dorsalis (845); Tuberculosis (887). 

Diseases of Bones, Joints, and Muscles.—Ankylosis (136); Arthritis (146); 
Arthritis Deformans (147); Bone, Fractures of (185); Bone, Inflamma¬ 
tion of (186); Bone, Softening of (188); Dislocation (267); Face, 
Atrophy of (336); Flatfoot (347); Gout (369); Hip-Joint, Congenital 
Dislocation of (435); Hip-Joint, Inflammation of (436); Hunch¬ 
back (445); Jaw, Dislocation of (489); Joints, Diseases of (490); 
Limping (515); Lumbago (522); Mastoid, Diseases of (541); Mus¬ 
cular Atrophy (586); Nose, Curvature of (603); Nose, Fracture of 
(604); Pes £quinus (693); Rheumatism, Articular (729); Rheuma¬ 
tism, Muscular (733); Rickets (735); Scrofula (768); Spasm (809); 
Sprain (818); Stiff Neck (825); Teeth (854); Vertebral Column, 
Curvatures of (924); Wryneck (952). 

Diseases of the Heart and Circulatory System.—Addison’s Disease (103); 
Aneurism (134); Arteries, Diseases of (145); Embolism (302); Heart, 
Diseases of (414); Lymphadenitis (530); Lymphangeitis (530); Peri¬ 
carditis and Hydropericardium (688); Spleen, Diseases of ffU7); 
Varicose Veins (913); Veins, Inflammation of (919). 

Diseases of the Kidneys and of the Genito-Urinary System.—Albuminuria 
(106); Bladder, Diseases of (176); Bubo (204); Chancroid (216); 
Diabetes Insipidus (258); Diabetes Mellitus (258); Epididymitis 
(306); Foreskin, Diseases of (351); Gonorrhea (365); Hematuria 
(423); Hydrocele (446); Impotence (458); Kidneys, Diseases of 
(493); Prostatitis (715); Seminal Losses (773); Stricture of the 






CONTENTS 


Urethra (835); Testicles, Diseases of (863); Uremia (905); Venereal 
Disease (919). See also under Female Functions and Disorders. 

Diseases of the Liver and of the Alimentary System.—Abdominal Pains 
(101); Anus, Fissure of (141); Appendicitis (141); Biliousness (174); 
Breath, Foul (200); Cholera Asiatica (226); Cholera Infantum (229); 
Cholera Morbus (230); Colic (240); Constipation (242); Dysentery 
(288); Eructation (313); Esophagus, Diseases of (316); Fecal Vomit¬ 
ing (341); Flatulence (347); Gastric Fever (359); Heartburn (421); 
Hematemesis (422); Hemorrhoids (431); Intestines, Diseases of 
(475); Liver, Diseases of (517); Mucous Colic (583); Peritonitis 
(689); Rectum, Diseases of (723); Stomach, Diseases of (825); 
Stomatitis (835); Typhoid Fever (899); Vomiting (929). 

Diseases of the Respiratory Apparatus.—Asthma (153); Breath, Shortness 
of (200); Bronchitis (201); Chest, Dropsy of (218); Colds (239); 
Coryza (248); Cough (250); Diphtheria (263); Eustachian Tube, 
Catarrh of (319); Hay-Fever (407); Hemoptysis (424); Larynx, 
Diseases of (501); Lungs, Diseases of (522); Nasopharyngeal Tonsil, 
Enlargement of (592); Ozena (655); Pharyngitis (693); Pleural Cavi¬ 
ty, Diseases of (698); Pleurisy (699); Tonsillitis (872); Tuberculosis 
of the Lungs (888). 

Dose Tables of Drugs and Pharmaceutical Preparations, with Indi¬ 
cation of their Uses in Medicine. 973-998 

Drugs and Their Uses.—Aconite (103); Alkaloids (113); Almond, Bitter 
(116); Aloes (116); Alum (116); Ammonia (117); Amylene Hydrate 
(118); Amyl Nitrite (118); Amylopsin (119); Analgesics (119); 
Anesthetics (132); Anise (135); Anthemis (136); Antimony (137); 
Antipyrin (138); Antiseptic (138); Arnica (144); Arsenic (145); 
Asafetida (151); Asarum (152); Asclepias (152); Aspidium (153); 
Astringents (154); Atropin (155); Balsam of Peru (159); Balsam 
of Tolu (159); Belladonna (171); Benzin (171); Benzoin (171); Bis¬ 
muth (175); Bitters (175); Bryonia (204); Buchu (205); Cade, Oil 
of (207); Caffein (207); Calcium (208); Calomel (208); Calumba 
(208); Camphor (209); Cannabis Indica (209); Cantharides (210); 
Carbolic Acid (210); Cascara Sagrada (211); Castor-Oil (211); Cheno- 
podium (218); Chloral (224); Chlorate of Potash (225); Chloroform 
(225); Cimicifuga (231); Cinchona (231); Cinnamon (232); Citric 
Acid (232); Cloves (235); Cocain (236); Codein (237); Cod-Liver 
Oil (237); Colchicum (238); Collodion (240); Colocynth (241); 
Conium (241); Copaiba (247); Copper (248); Creolin (253); Creosote 
(253); Croton-Oil (253); Cubebs (253); Cyanide of Potassium (254); 
Diastase (262); Digitalis (262) ; Domestic Remedies (267); Dul¬ 
camara (283); Elaterinum (298); Ether (318); Eucalyptus (318); 
Euonymus (319); Eupatorium (319); Fel Bovis (341); Figs (344); 
Flaxseed (348); Foeniculum (348); Formaldehyde (352); Galla 
(353); Gaultheria (359); Gelsemium (359); Gentian (360); Gera¬ 
nium (360); Ginger (361); Glucose (363), Glycerin (363); Glycyr- 
rhiza (364); Gossypium (369); Grindelia (371); Guaiac (372), 






CONTENTS 


Xlll 


Guaiacol (372); Guarana (372); Gynocardia (401); Hamamelis 
(405); Hedeoma (422); Hemlock (423); Honey (442); Humulus 
(445); Hydrastis (445); Hydrochloric Acid (446); Hyoscyamus 
(447); Ichthyol (454); Infusions (465); Iodin (485); Iodoform (486); 
Ipecac (486); Iron (486); Jalap (488); Juniper (491); Kamala (492); 
Kaolin (492); Kino (499); Krameria (500); Lanolin (501); Lavender 
(504); Lead (504); Lime (513); Lime-water (514); Limonis (514); 
Lithium (517); Lobelia (561); Lysol (530); Manna (534); Mastic 
(541); Medicines (555); Menthol (570); Mercury (570); Mucilages 
(583); Musk (588); Myrrh (589); Naphthalene (592); Nux Vomica 
(633); Oils, Fixed (646); Oils, Volatile (646); Oleoresins (648); Olive- 
Oil (648); Opium (648); Oxalic Acid (654); Oxygen (654); Pancreatic 
Extracts (671); Papoid (679); Paraldehyde (679); Paregoric (682); 
Pepo (688); Pepper (688); Peppermint (688); Pepsin (688); Per¬ 
manganate of Potassium (692); Peroxid of Hydrogen (692); Peru¬ 
vian Bark (693); Phenacetin (695); Physostigma (696); Pilocarpus 
(696); Podophyllum (701); Pomegranate (707); Potassium, Salts of 
(708); Prunus Virginiana (716); Pyrogallol (721); Quassia (721); 
Quercus (721); Resorcin (729); Rhubarb (735); Rochelle Salt (738); 
Rosin (738); Rue (738); Saccharin (742); Salicin (742); Salicylic 
Acid and its Salts (742); Sandal Wood (744); Sanguinaria (745); 
Santonin (761); Sarsaparilla (761); Savin (761); Scammony (763); 
Scoparius (767); Scopolamin (768); Seidlitz Powder (772); Senega 
(775); Senna (777); Sirup (792); Sodium, Salts of (808); Squill 
(820); Stillingia (825); Stramonium (835); Strophantus (836); 
Strychnin (836); Sugar of Milk (839); Sulfonal (841); Sulfur (841); 
Sulfuric Acid (842); Suppository (843); Sweet Spirit of Niter (843); 
Tamarind (848); Tannic Acid (848); Tansy (848); Tar (852); Tar¬ 
taric Acid (852); Thymol (865); Tinctures (870); Trional (875); 
Turpentine (899); Uva-Ursi (906); Valerian (913); Veratrum (923); 
Veronal (923); Warburg’s Tincture (930); Zinc Salts (954). 

Eye, Ear, and Nose Affections—Speech Disturbances.—Amaurosis (117); 
Amblyopia (117); Auditory Nerve (155); Blindness (181); Cataract 
(213); Colorblindness (241); Coryza (248); Deafness (255); Ear, 
Diseases of (291); Ear, Itching of (295); Ear, Polypi of (295); 
Ear, Ringing of (295); Ear-Wax Plugs (296); Eustachian Tube, 
Catarrh of (319); Eye, Diseases of (327); Eye, Injuries to (333); 
Eye, Instillations into (334); Eyelashes, Affections of (334); Eye¬ 
lids, Blinking of (334); Eyelids, Diseases of (335); Glaucoma (362); 
Hearing, Deficiency of (412); Hemeralopia (423); Lacrimal Gland, 
Sac, and Duct, Diseases of (500); Nasopharyngeal Tonsil, Enlarge¬ 
ment of (592); Nosebleed (602); Nose, Curvature of (603); Nose, 
Foreign Bodies in (604); Nose, Polypi in (605); Nyctalopia (633); 
Ozena (655); Pupils, Changes in (719); Scotoma (768); Sight, Disturb¬ 
ances of (791); Speech Disturbances (810); Squinting (821); Sty 
(837); Vocal Cords, Paralysis of (927); Voice and Speech (927); 
Voice, Care of (929). 

Febrile and Contagious Diseases—Anthrax (136); Black-Water Fever 
(175); Chicken-Pox (219); Cholera (226)-; Dengue Fever (257); Diph- 





XIV 


CONTENTS 


theria (263); Erysipelas (314); German Measles (360); Influenza 
(464); Malaria (531); Measles (543); Meningitis (559); Mumps 
(584); Plague (697); Pleurisy (699); Pneumonia (526); Puerperal 
Fever (717); Pyemia and Septemia (720); Relapsing Fever (726); 
Scarlatina (763); Smallpox (914); Typhoid (899); Typhus (902); 
Whooping-Cough (936); Yellow Fever (952). 

Female Functions and Disorders.—Abortion (101); Breast, Inflammation 

of (198); Breast, Painful Affections of (200); Childbed (220); Hymen 
(447); Menopause (562); Menstruation (562); Ovaries, Diseases of 
(652); Ovarian Tubes, Diseases of (653); Parturition (682); Preg¬ 
nancy (710); Puerperal Fever (717); Sterility (824); Vagina, Dis¬ 
eases of (912); Womb, Diseases of (939). 

Food and Drink.—Alcohol (106); Beer (170); Beverages (172); Bitters 
(175); Bread (195); Butter (206); Cacao (207); Cereals (215); 
Cheese (217); Chocolate (226); Coffee (238); Diet (262); Egg (297); 
Foodstuffs (349); Fruits (353); Fruit-Wines (354); Ice (453); Kephir 
and Kumiss (492); Legumes (505); Liquors (516); Malt (533); Meat 
(545); Mushrooms (588); Nourishment for the Sick (606); Nursing 
(613); Nursling, Nourishing of (627); Oleomargarin (647); Potatoes 
(708); Spices (816); Sugar (838); Tea (853); Vegetables (917); 
Vegetarianism (917); Water (931); Wine (938). 

Gymnastics and Recreative Exercises.—Bicycling (172); Exercise (319); 

Fencing (341); Gymnastics, Curative, Orthopedic, Respiratory, and 
Swedish (372); Mountain-Climbing (582); Sea Trips (772); Skating 
(792); Swimming (843). See also under Baths — Cures — Massage. 

Nervous and Mental Diseases.—Brain, Apoplexy of (190); Brain, Con¬ 
cussion of (192); Brain, Diseases of (193); Brain, Softening of (194); 
Catalepsy (212); Delirium (257); Epilepsy (307); Hysteria (450); 
Imbecility (454); Insanity (468); Maniacal Delirium (533); Menin¬ 
gitis (559); Mental Diseases (563); Nervous Prostration (596); Neu¬ 
ralgia (599); Neuritis (601); Sciatica (767); Shaking Palsy (779); 
Sleeplessness (800); St. Vitus’s Dance (822); Tabes Dorsalis (845). 

Poisoning.—Absinthism (102); Alcoholism (107); Anilin-Poisoning (135); 
Antimony (137); Arsenic-Poisoning (145); Auto-Intoxication (156); 
Belladonna-Poisoning (171); Blood-Poisoning (183); Cadaver Poisons 
(207); Cannabis Indica (209); Cantharides (210); Carbolic-Acid 
Poisoning (210); Coal-Gas Poisoning (235); Cocain-Poisoning (236); 
Copper (248); Cyanide-of-Potassium Poisoning (254); Digitalis (262); 
Dyestuffs, Poisonous (287); Ergot-Poisoning (311); Hemlock- 
Poisoning (423); Lead-Poisoning (504); Mercury-Poisoning (570); 
Mushroom-Poisoning (587); Opium-Poisoning (648); Oxalic Acid 
Poisoning (654); Phosphorus-Poisoning (695); Poisoning [General 
article] (701); Prussic Acid (716); Ptomain-Poisoning (716); Pyemia 
and Septemia (720); Snake Bites (801); Strychnin-Poisoning (836) 
Thorn-Apple Poisoning (865); Tobacco-Poisoning (870); Zinc Salts 
(954). See also articles on various poisonous drugs. 




CONTENTS 


xv 


Poisons, their Effects and Antidotes, and the Treatment of Poison¬ 
ing. Arranged for Ready Reference. 957-970 

Sanitation—Prophylaxis—Medicine—Nursing.—Allopathy (115); Antisep¬ 
tic (138); Beard (167); Bed (168); Climate and Disease (233); 
Cremation (251); Dead, Disposal of (255); Disinfection (265); 
Domestic Remedies (267); Dress (271); Dust Diseases (283); 
Dwelling-Places (284); Enema (302); Eye, Care of (323); 

Hair, Care of (401); Hardening (405); Health-Care of Chil¬ 
dren (410); Homeopathy (438); Ice (453); Immunity (457); Incu¬ 
bation Periods (460); Infection (461); Inhalations (465); Light 

(509); Massage (535); Medicine, History of (550); Medicines (555); 

Mortality (573); Nails, Care of (590); Nose Irrigation (604); Nurs¬ 
ling, Care of (616); Observation of the Sick (637); Occupation Dis¬ 
eases (641); Orthopedics (649); Osteopathy (650); Packs (656); 

Parturition (682); Poultices (708); Sanitation (745); School (765); 
Sea Trips (772); Sewage, Disposal of (777); Sick, Nursing of (782); 
Sick-Room (787); Skin, Care of (793); Sleep (798); Soil, The (808); 
Springs, Mineral (818); Suggestion (839); Teeth, Care of (854); 
Tropics (885); Urine (905); Vaccination (906); Voice, Care of (929); 
Widal Test (937); Wounds, Treatment of (949). 

Skin-Diseases.—Acne (103); Barber’s Itch (161); Birthmarks (174); 
Blackheads (175); Eruption (313); Erysipelas (314); Favus (340); 
Fish-Skin Disease (346); Herpes (434); Hives (436); Itching (487); 
Lupus (529); Nails, Diseases of (590); Nose, Red (605); Pemphigus 
(687); Prickly Heat (714); Ringworm (737); Scabies (761); Skin 
Blotches (793); Skin Diseases (797); Skin, Scaling of (798); Wens 
(936). 

Surgery—Deformities— Accidents— Inflammations—First Aid. — Abscess 
(102); Amputation (118); Anesthesia (132); Angiomata (134); 
Anus, Artificial (141); Artificial Respiration (147); Asphyxia (152); 
Autopsy (157); Bandages (159); Bed-Sores (170); Boil (184); Bone, 
Fractures of (185); Bone, Inflammation of (186); Bow-Legs (189); 
Bubo (204); Burns (205); Carbuncle (211); Castration (212); Cathe- 
terism (214); Chilblains (220); Circumcision (232); Clubfoot (235); 
Contusions (244); Death, Apparent (256); Dislocation (267); Dropsy 
(280); Drowning (281); Ear, Foreign Bodies in (291); Ear, Polypi 
of (295); Ear-Wax Plugs (296); Electrical Accidents (298); Esopha¬ 
gus, Foreign Bodies in (317); Eye, Injuries to (333); Fainting (338); 
Fistula (346); Flatfoot (347); Freezing (353); Furuncles (354); 
Gall-Stones (355); Ganglion (357); Glass Eye (362); Goiter (364); 
Harelip and Cleft Palate (406); Heat-Stroke (421); Hemorrhage and 
its Control (425); Hip-Joint, Congenital Dislocation of (435); House¬ 
maid’s Knee (444); Hunchback (445); Hydrocele (446); Inflam¬ 
mation (463); Insect Stings and Bites (474); Jaw, Dislocation of 
(489); Joints, Diseases of (490); Knock-Knee (499); Larynx, Foreign 
Bodies in (502); Lightning Stroke (512); Nail, Ingrowing (589); 
Nose, Artificial (602); Nose, Foreign Bodies in (604); Nose, Fractures 
of (604); Nose, Polypi in (605); Ovariotomy (654); Pes Equinus 









XVI 


CONTENTS 


(693); Pus (720); Ranula (723); Ribs, Fractures of (735); Run- 
Round (738); Rupture (739); Skin, Foreign Bodies in (798); Snake 
Bites (801); Snow-Blindness and Effects of Cold (804); Sprain (818); 
Squinting (821); Stricture of the Urethra (835); Suffocation (837); 
Suicide (841); Sunstroke (842); Talipes Calcaneus (847); Teeth 
(854); Tongue-Tie (872); Ulcer (902); Unconsciousness (904); 
Varicose Veins (913); Vivisection (926). 

Symptoms.—Appetite, Loss of (144); Ascites (152); Ataxia (154); Bil¬ 
iousness (174); Breath, Foul (200); Breath, Shortness of (200); 
Chest, Pains in (218); Coccygeal Pain (237); Colic (240); Cough 
(250); Cyanosis (254); Dropsy (280); Ear, Ringing of (295); Eructa¬ 
tion (313); Excitement (319); Face, Pains of (336); Fainting (338); 
Fecal Vomiting (341); Fever (342); Flatulence (347); Hawking 
(407); Headache (409); Heart, Palpitation of (417); Heartburn 
(421); Hematemesis (422); Hematuria (423); Hemophilia (424); 
Hemoptysis (424); Hiccup (435); Hoarseness (437); Impotence 
(458); Itching (487); Jaundice (488); Limping (515); Muscae Voli- 
tantes (585); Nausea (594); Obsessions (639); Pain (656); Pupils, 
Changes in (719); Scotoma (768); Seminal Losses (773); Sleepless¬ 
ness (800); Vertigo (925); Vomiting (929). 

Tropical Diseases. 875-885 

Glossary . 1001-1021 


Index 


1025-1059 







ILLUSTRATIONS 


Plate 

I. 

u 

II. 

u 

III. 

u 

IV. 

11 

V. 

u 

VI. 

u 

VII. 

u 

VIII. 

u 

IX. 

u 

X. 

u 

XI. 

<< 

XII. 


Manikin 


Plate XIII. 

a 

XIV. 

a 

XV. 

u 

XVI. 

u 

XVII. 

u 

XVIII. 

u 

XIX. 

11 

XX. 

a 

XXI. 

u 

XXII. 

u 

XXIII. 

u 

XXIV. 


COLORED AND FULL-PAGE PLATES 

Volume I 

FACING PAGE 

Muscles of the Human Body (from the front). 20 

Muscles of the Human Body (from the back). 44 

The Chest and Abdomen (after removal of skin and muscles) . 104 / 
Deep-lying Structures of Chest and Abdomen (from the front) 132 / 


Blood-vessels of the Chest and Abdominal Cavity .... 180 / 

Left Ventricle of Heart; Thrombus in Vein. 228 / 

Arteries of the Neck and Head. 268 

Arteries and Muscles of the Arm and of the Thigh . . . . 316 ^ 

Brain and Spinal Cord (side view). 360 

External Nerves of the Head and Neck. 408 

Nerves of the Upper Half of the Body. 440 

Various Affections of the Eye. 484 ' 


following page 530 v' 


Volume II 

FACING PAGE 


Bladder- and Gall-Stones. 554 

Skin Discolorations in Various Diseases. 598 

Roentgen Rays. 634 

Bone Injuries. 678 

Normal and Diseased Conditions of the Thorax. 714 

Normal and Diseased Conditions of the Face. 742 

Comparison of Different Foods. 774 

Fungi (edible and poisonous). 826 

) Positions of the Lips in Uttering 

\ Sounds for Lip-Reading ... . 870 , 871 

Herbs (poisonous and non-poisonous). 906 

Flowering Plants. 938 


XVII 




















XV111 


ILLUSTRATIONS 


TEXT ILLUSTRATIONS 

(Note: Volume I comprises pages i— 53 °>' volume II, pages I he reader 

should bear this in mind when wishing to consult an illustration) 

PAGE 

Abdomen, its Wall being Removed. *42 

Abdomen, Longitudinal Section through the.94° 

Abdominal Organs. 5*8 

Affusion of the Back.933 

Affusion of the Body in Front.934 

Affusion of the Knees.935 

Affusion of the Legs.933 

Affusion of the Neck.935 

Air-box for Furnace.75^ 

Air-cushions.7 ^ 2 

Albino. 105 

Amebae, Intestinal. 84 

Anchylostoma Duodenale. 120 

Ankle, Ligaments of.45 

Anthrax-bacillus. 82 

Apparatus for Cooling the Head. 709 

Apparatus Enabling Patients to raise Themselves in Bed. 784 

Apparatus, Gymnastic. 389 , 390 , 400 

Apparatus, Hydrotherapeutic. 932 

Appendix, Vermiform. 142 

Aquiline Nose. 603 

Arch-supporter for Flatfoot. 347 

Arm, Bones of. 26 , 27 

Arm, Muscles of.n 

Arm, Pressure on, to stop Bleeding. 430 

Artery, Bleeding from. 426 , 429 

Arthritis, Deformity of Hand Affected with .. 148 

Artificial Respiration. 148 , 149 , 150 , 151 

Asylum for Insane. 466 , 467 , 468 

Atrophy, Muscular, in an Adult. 586 

Atrophy, Muscular, in a Child. 585 

Atrophy, Muscular, of Hand. 586 

Attitude of Body in Presence of Respiratory Difficulties. 593 

Attitudes, Proper and Harmful, of Body when Writing . . . 324 , 325 , 925 

Baby, See Nursling 

Baldness. 403 

Balloon Syringe. 303 

Bandage to arrest Bleeding . 427 , 428 

Bandage for the Ear. 290 , 293 

Bandage for Navel Rupture. 595 

Bandage to protect the Eye. 330 

Bandages, Surgical. 159 , 160 , 161 

Bandy Legs. 189 

Bath Thermometer. 7 go 
















































ILLUSTRATIONS 


XIX 


PAGE 

Baths.163, 164, 165, x66 

Bed for Patients who soil Themselves.i6g 

Bedpan.221, 7go 

Bedside Table. 7go 

Beef, Different Cuts of, in Live Animal.547 

Bladder.X4 2 

Bleeding, Control of.426, 427, 428, 429, 430 

Blood-cells.x6 

Blood, Diagram showing Circulation of.64 

Body-bath.^4 

Body-louse.508 

Boiler, Connections between Water-back and.758 

Bones of Foot.34 

Bones of Hand.34 

Bones of the Human Body...26, 27 

Bones of the Skull.29 

Bony Tissue.10 

Bottle in which to prepare Kephir.492 

Bow-legs.189 

Breathing, Expression and Attitude caused by Difficulties in . 592, 593 

Breathing, Rise and Fall of Ribs during.52 

Broken Bones, Methods of Healing of.90 

Bronchial Tubes.51 

Brushing the Teeth. 855,857 


Caecum .142 

Cancerous Ulcer on Lip.516 

Carious Tooth.860 

Carotid Artery, Pressure to arrest Bleeding from.429 

Carrying a Patient.786, 787 

Cartilage Cells.10 

Cellar Construction.748 

Cells, Blood-.16 

Cells, Cartilage-.10 

Cells, Ciliated.7 

Cells, Nerve-.13 

Cells of Epidermis.2 

Changing the Sheet under a Patient.788 

Chest and Waist in Woman, Showing Deformity from Tight Lacing ... 33 

Chest, Bones of.26, 27 

Child suffering from Cretinism.869 

Child suffering from Rickets.73^ 

Ciliated Cells. 7 

Circulation of Blood.64 

Clinical Thermometer. 637 

Clubfoot. 2 36> 847 

Cobra, Head of.803 

Combination Suit for Women.279 

Commode. 79 ° 

Compound Gland. 7 

Connective Tissue.8 





















































XX 


ILLUSTRATIONS 


PAGE 

Constriction due to Tight Waistband. 2 7 & 

Consumption, Tent Hospital for Treatment of.895 

Contraction of Muscle. 11 

Convulsions, Hysterical. 45 2 

Correct Attitude when Writing . . . . 3 2 4 

Crab-louse. 5°8 

Craig Colony for Epileptics.308, 309, 310 

Crematory at Fresh Pond, Long Island, N. Y. 251 

Cretin. 455 > 869 

Cretinism, Child Before and After Treatment for.869 

Cupping-glasses.254 

Curvatures of the Spinal Column.924 

Cylindrical Epithelium of Skin.7 

Davy Lamp.837 

Deformities caused by Ergot-poisoning.312 

Deformity of Chest from Tight Lacing.33 

Deformity of Finger-nails ..591 

Deformity of Foot due to Badly Fitting Shoe.276 

Deformity of Hand in Rheumatoid Arthritis.148 

Diaphragm, Movement of, during Breathing.52 

Dislocation of the Hip-joint.434, 435 

Displacement of the Stomach.831 

Drains, Ventilation of.749 

Dress, Ideal Mode of.279 

Dropping-bottle.559 

Dust, Protection against Inhaling.284 

Dwarf.24 

Ear and its Internal Structures.71 

Ear-bandage.290, 293 

Ear-syringe.293 

Ear-trumpets.413 

Ear, Washing of, with Syringe.294 

Echinococcus of the Dog.520 

Eggs of Head-louse.508 

Elbow-joint.41 

Electric-light Bath.511 

Elephantiasis in Legs.301 

Elevated Position of Arm and Leg.788 

Emergency Splints for Fracture.186, 187 

Enema, How to give Baby an.620 

Enema Syringes.303 

Epileptics, Hospital for.308 

Epithelium, Cylindrical.7 

Ergot of Rye.'.312 

Ergot-poisoning, Deformities caused by.312 

Eruption of Smallpox.916 

Examination of Throat, Method of holding Patient for.264 

Exercises to Improve Control of Muscles.845 

Eye, Bandage for.330 




















































ILLUSTRATIONS 


xxi 


Eye, External View of 
Eye, Longitudinal Section of. 

Eye-dropper. 

Eye-glasses for Protection . 
Eye-shade. 


Fainting Person, How to Support. 

Fango, Application of. 

Fatty Tissue. 

Female Pelvis. 

Female Type of Breathing. 

Femoral Rupture . 

Fever-chart of Malaria. 

Fever-chart of Measles. 

Fever-chart of Pneumonia . . 

Fever-chart of Relapsing Fever. 

Fever-chart of Smallpox. 

Fever-chart of Typhoid. 

Fibers in Connective Tissue. 

Finger-nail, Deformed. 

Finger-nails, Trimming of. 

Finger-nails, White Spots on. 

Finsen Light Treatment.513 

Fistula, Rectal. 

Flatfoot. 

Flatfoot, Arch-supporter for. 

Floating, Correct and Incorrect Attitudes in.280, 281 

Foot, Bones of.26, 27, 37 

Foot, Deformity of.693 

Foot, Deformity of, due to Improper Footwear.276 

Foot Impressions.38 

Foot, Ligaments of.45 

Foot-bath, Alternating.165 

Fountain-syringe.303, 912 

Fracture, Methods of Healing of.90 

Fracture of Bones of Arm.184 

Fracture of Thigh-bone.185 

Fungus of Ringworm.82 

Furnace, Cold-air Box for.756 


PAGE 

69 

69 

334 

328 

789 


338 

339 
9 

35 

52 

740 

88 

544 

527 

726 

9 i 5 

88 

8 

59i 

590 

591 
5*4 
725 

38 

347 


Gangrene, Moist and Dry. 

Giant. 

Gland, Compound. 

Gland, Simple. 

Glycerine Syringe. 

Goggles. 

Goiter. 

Gonococci. 

Government Hospital for Insane, Washington, D. C. 

Graduated Medicine Glass. 

Gray Hair. 


- ... 358 

. ... 24 

* • • • 7 

. . . . 7 

* • • • 3°3 

. ... 805 

. ... 364 

. ... 83 

. 466, 467, 468 

* - • - 558 

. 402 






















































XXII 


ILLUSTRATIONS 


PAGB 

Gymnastic Apparatus. 3 8 9 ? 39 °? 4 co 

Gymnastic Combination Exercises.386, 387, 389 

Gymnastic Exercises for the Arm.375 37^? 377? 37 8 

Gymnastic Exercises for the Hand and Fingers.38° 

Gymnastic Exercises for the Head. 373 ? 374 

Gymnastic Exercises for the Legs. 3 8 3 ? 3 8 4 ? 385, 386 

Gymnastic Exercises for the Trunk.3 81 ? 3 82 

Gymnastic Exercises, Orthopedic. 39 1 

Gymnastics, Respiratory. 393 > 394 ? 395 ? 39^ 

Gymnastics, Swedish. 397 ? 39 8 ? 4 °° 


Hair, Gray, Circumscribed Areas of 

Hair, Loss of. 

Half-bath. 

Hand and Arm Bath. 

Hand, Bones of. 

Hand, Ligaments of. 

Hands Affected by Paralysis 
Handwriting of Paretics . 

Harelip . 

Harmful Attitude when Writing . 

Harvest-tick. 

Head, Abnormal Largeness of . 
Head, Abnormal Smallness of 
Head, Apparatus for Cooling the 

Head, Cross-section of. 

Head, Longitudinal Section of . 
Headache Manipulations . 

Head-louse. 

Hearing, Organs of. 

Hemorrhage, Control of ... 
Hip-joint, Dislocation of ... 

Plitting-exercises. 

Horse-chestnut. 

Hose-supporters. 

Hospital for Consumptives . 

Hospital for Epileptics. 

Hospital for Insane. 

Hot-air Bath for Shoulder . 

Hunchback. 

Hydrotherapeutic Apparatus . 
Hydrotherapeutic Room . 
Hypnotism, Rigidity caused by . 
Hysteria, Convulsions of . 


.402 

.403 

.16s 

.166 

. . . . 26, 27, 34 

.42 

.680 

.i 94 

.406 

- - - - 325? 925 

.407 

. 456 

.456 

.7°9 

.48 

.927 

.4°9 

.5° 8 

. 7 1 

426, 427, 428, 429, 430 

.... 434, 435 

.845 

.865 

.412 

.895 

.308 

. 466, 467, 468 

.444 

.445 

. 932 

- • - * 3°9? 3 J o 

.449 

. 452 


Ice, Rescuing Persons who have Broken through the.281, 282 

Ice-bag Suspended over Abdomen.691 

Impressions of the Teeth of Snakes.802 

Incineration Apparatus, Cross-section of.252 

Infant. See Nursling. 

Inguinal Rupture.739, 740 





















































ILLUSTRATIONS xxiii 


PAGE 

Insane, Hospital for.'.466, 467, 468 

Insanity, Facial Expressions of People Suffering from.473 

Insole for Correction of Flatfoot.347 

Intestinal Occlusion.480, 481 

Intestines. 142 

Intussusception of the Intestine.481 

Irrigator for the Nose.604 

Irrigator, Rectal.303 

Itch-mite, The, and its Burrows.762 

Joint of Elbow.41 

Joint of Knee.44 

Joint of Shoulder.40 

Joint, Section of. 39 

Joints and Ligaments of Ankle and Foot.45 

Joints and Ligaments of Pelvis.43 

Joints and Ligaments of Wrist and Hand.42 

Joints of entire Body.26, 27 

Kephir Bottle .492 

Kitchen-boiler, Connections between Range and.758 

Knee-joint.44 

Knock-knee.500 

Lamp-shade.789 

Larynx, External Structure of, from in Front.49 

Larynx, External Structure of, from the Side.49 

Larynx, Interior of, from in Front.50 

Larynx, Interior of, from the Side.50 

Larynx, Trachea, and Bronchi.51 

Laying down a Patient.785 

Leader to Carry away Rain from Foundation.764 

Leech, Manner of Applying.505 

Leg, Bones of.26, 27 

Leg, Elevation of.788 

Lice. 5°8 

Lifting a Patient. 7 ^ 3 > 7^4 

Ligaments of Ankle and Foot. 45 

Ligaments of Pelvis. 4 2 

Ligaments of Wrist and Hand. 4 2 

Light-bath Apparatus, Electric. 5 11 

Light-treatment, Finsen’s. 5 I 3 » 5 I 4 

Lightning Stroke, Markings caused by.- 5 12 

Limbs, Abnormal Shortness of. 57 1 

Lip, Cancerous Ulcer on.5*6 

Liver, Diagrams showing Relations of.- - - • i 4 2 > 5*^ 

Localizations of Pain.663, 665, 667, 668, 670, 672, 675 

Locomotor Ataxia, Swaying of Body in.844 

Lungs, Diagram showing Relations of. 5 2 3 

Macrocephalia. 45 ^ 

Malaria, Fever-chart of.88 





















































XXIV 


ILLUSTRATIONS 


PAGE 

Male Pelvis. 35 

Maniacal Delirium, Girls suffering from. 533 

Manic-Depressive Insanity, Facial Expressions Characteristic of . - - - 473 

Manipulations to Relieve Headache. 4°9 

Manipulations to Relieve Neuralgia.6oo 

Manipulations to Relieve Vomiting. 93 ° 

Massage by Percussion. 54 2 

Massage for Headache. 4°9 

Massage of Back. 539 > 54 ° 

Massage of Fingers. 535 

Massage of Forearm. 537 

Massage of Hand. 536 

Massage of Leg.53 8 

Massage of Neck. 54 ° 

Massage of Throat. 54 1 

Massage of Upper Arm.537 

Measles, Fever-chart of. 544 

Meat, Comparative Value of, in Live Animal.547 

Medicine Glass, Graduated.558 

Microcephalia. 45 6 

Micromelia, Child suffering from.571 

Motor Nerve.14 

Mouth and Pharynx, View of.55 

Muscle, Striated.n 

Muscle-Fibers, Smooth.12 

Muscles of Upper Arm.n 

Muscular Atrophy in an Adult.586 

Muscular Atrophy in a Child, Progressive.585 

Muscular Atrophy of Hand.586 

Nail-scissors, Helferich’s.589 

Nasal Irrigator.604 

Nasal Respiration, Facial Expression caused by Prevention of.592 

Navel Rupture, Bandage for.595 

Nerve, Optic.69 

Nerve-cell.13 

Nerve-fibers, Course of.14 

Neuralgia, Nageli’s Manipulations for.600 

Nose, Curvatures of.603 

Nursling, Correct and Incorrect Manner of Holding and Carrying a . 618, 619 

Nursling, How to give an Enema to a.620 

Nursling, How to Measure the Body-temperature of a.626 

Nursling, Proper Scale for Weighing a.632 

Occlusion of the Intestine.480, 481 

Operating-room.468 

Optic Nerve.14 

Organs, Abdominal.518 

Orthopedic Gymnastics.391 

Ox, Diagram showing Different Cuts of Beef in the.547 

Oxygen Tank, showing Method of Administering.6=54 


















































ILLUSTRATIONS 


XXV 


PAGE 


Packs, Application of.655, 657, 658, 659, 660, 661 

Pain, Localizations of.663, 665, 667, 668, 670, 672, 675 

Palates, Hard and Soft.rr 

Palsy, Shaking, Characteristic Attitude in.779 

Paralysis, Hands Affected by.680 

Paretics, Handwritings of. 

Pasteurizer, Freeman’s.629 

Patient, Correct and Incorrect Methods of Carrying a.786, 787 

Patient, How to Lift a.783, 784 

Pelvic Organs in the Female.940 

Pelvis, Bones of.26, 27 


Pelvis, Female .... 
Pelvis, Joints and Ligaments of 

Pelvis, Male. 

Percussion Massage . 

Pes Equinus. 

Pessaries. 

Pinworm. 

Pipette. 

Pneumonia, Fever-chaJt of . 

Poison Label. 

Poultices. 

Powder Syringe. 

Prolapse of the Womb 
Proper Attitude when Writing 
Protection Glasses .... 


710 


35 

42 

35 

542 

693 

693 

948 

334 

5 2 7 

558 

711 

558 

943 

925 

328 


Rattlesnake, Head of. 

Reading-table for Patients. 

Rectal Fistula. 

Red Blood-corpuscles. 

Refrigerator. 

Relapsing Fever, Spirillum of. 

Relapsing Fever, Temperature-chart of. 

Rescuing a Suffocated Person. 

Rescuing Persons who have Broken through the Ice 

Respiration, Artificial. 

Respiration, Female Type of. 

Respiration, Nasal, Facial Expression caused by Prevention of 

Respiration, Rise and Fall of Ribs during. 

Respirator. 

Respiratory Gymnastics. 

Retroversion of the Womb. 

Ribs. 

Ribs, Rise and Fall of, during Respiration. 

Rickets, Child suffering from.- 

Rigidity of Limbs caused by Hypnotism. 

Ringworm, Fungus of. 

Roentgen Rays. 

Rubber Svrinee. 

0 <0 


.803 

. 79 1 

.725 

.16 

- - - 753 » 754 

.84 

.726 

.838 

281, 282 

148, 149, 150, 151 

. 52 

.... 592 

.52 

.284 

393 ) 394 , 395 , 39 ^ 

.942 

. 26, 27 

. 52 

. 736 

. 449 

.82 

. 93, 184, 185, 434 

. 3°3 
















































XXVI 


ILLUSTRATIONS 


PAGE 

Rupture, Femoral. 74 ° 

Rupture, Inguinal. 739 > 74 ° 

Saddle-nose.603 

Scale for Weighing an Infant.632 

Secretory Nerve. J 4 

Sensory Nerve. J 4 

Shaking Palsy, Characteristic Attitude in. 779 

Sheet, Changing of, under a Patient.7^8 

Short Limbs. 57 1 

Shoulder-joint. 4 ° 

Shower-bath Apparatus.7 8° 

Simple Gland. 7 

Siphonage. 75 ° 

Sitz-bath.164 

Skeleton (back view).27 

Skeleton (front view).26 

Skin, Cross-section of.19 

Skin, Pavement Epithelium of.5 

Skull, Bones of.26, 27, 29 

Smallpox, Eruption of.916 

Smallpox, Fever-chart of.915 

Smooth Muscle-fibers .12 

Snake Bites, Teeth Impressions of.802 

Snow-goggles.805 

Spasm of the Neck Muscles.809 

Speech, Organs of.927 

Spinal Column.32 

Spinal Column, Curvatures of.924 

Spinal Vertebra.30, 31 

Spirillum of Relapsing Fever.84 

Spleen.142 

Splints for Fractures.186, 187 

Steam-bath Cabinet.822 

Steam-bath for the Face.823 

Stomach, Diagrams showing Relations of.142, 828 

Stomach, Displacement of.831 

Streptococci.82 

Striated Muscle.11 

Subclavian Artery, Pressure to arrest Bleeding from.429 

Suffocated Person, Method of Rescuing a .838 

Supporting a Fainting Person.338 

Swedish Gymnastics.397, 398, 400 

Syringe for the Ear.293 

Syringes, Different Kinds of.303 

Syringing the Ear.294 

Table for the Bedside.7go 

Talipes Calcaneus.847 

Tapeworms...520, 849, 850 





















































ILLUSTRATIONS xxvii 


PAGE 

Tattooing, Japanese.853 

Teeth, Brushing of the.855, 857 

Teeth, Carious.860, 861 

Teeth, Filling of Carious.861 

Temperature, How to Measure an Infant’s.626 

Temperature, Proper and Incorrect Methods of Measuring.638 

Tent Hospital for Consumptives.895 

Thermometer, Clinical.637 

Thermometer for the Bath.790 

Thorn-Apple, Seed and Fruit of.865 

Throat, Examination of, showing Manner of Holding Patient.264 

Tissue, Bony.10 

Tissue, Connective. 8 

Tissue, Fatty.9 

Tongue.55 

Tonsils.55 

Trachea (Windpipe).49, 50, 51 

Trichinae.874 

Trimming of Finger-nails.590 

Truss, Adjustment of.741 

Tubercle-bacillus.82 

Tuberculosis, Tent Hospital for Treatment of.895 

Typhoid, Fever-chart of.88 

Ulcer, Cancerous, on Lip. 516 

Ulcer of Leg.903 

Umbilical Rupture, Bandage for.595 

Underwear for Women.279 

Urinal. 79 ° 

Uterus, Prolapse of. 943 

Uterus, Retroversion of. 94 2 

Uvula. 55 

Varicose Veins and Ulcer of Leg.903 

Vein, Bleeding from.426 

Ventilation of Drains. 746 

Ventilation with Avoidance of Draft.760 

Vertebra, Spinal. 3 °> 3 1 

Vertebral Column. 3 2 

Vertebral Column, Curvatures of.924 

Vocal Cords. 5 ° 

Volvulus.481 

Vomiting, Nageli’s Manipulations to Relieve.930 

Wafer of Gelatin.55^ 

Waistband, Constriction caused by Tight.278 

Walking-exercises.846 

Water-back, Connections between Boiler and.758 

Water-closets and Traps. 7 5 1 > 7 5 2 

Water-cushion.782 

Water-treatment, Apparatus for. 93 2 



















































ILLUSTRATIONS 


xxviii 


PAGE 

White Blood-corpuscles.16 

White Spots on Finger-nails.591 

Window Ventilation.760 

Windpipe.49, 50, 51 

Womb, Prolapse of.943 

Womb, Retroversion of.942 

Wood-tick.946 

Wrist, Ligaments of.42 

Wryneck.952 


X-rays 


93, 184, 185, 434 
















PREFACE 

I N presenting to the American public this work on household 
medicine, the editors feel that they are supplying a need 
which in some quarters has been long felt, and in others 
is none the less actual because unappreciated—the need of some 
work of reference on medicine and hygiene which shall speak 
with the conservative authority of a responsible physician, and at 
the same time be couched in language which the intelligent lay¬ 
man can understand. Hitherto those who have felt the need of 
such a book have looked for it in vain, and others less discrimi¬ 
nating have turned for guidance to various volumes issued for 
thinly veiled commercial purposes, which contain instructions of 
very uncertain value. The mistaken theories gathered from such 
books and adhered to with the stubbornness of imperfect compre¬ 
hension have been one of the irritating obstacles which obstruct 
the work of the physician, and have led to a general condemna¬ 
tion on the part of the profession of all “doctor books” in the 
hands of the layman. Yet none would recognize more readily 
than the physician the advantage of finding in the patient and 
his friends a sane and sensible comprehension of the structure 
and functions of the human body, of the influences which com¬ 
monly affect them in health and disease, and of the results which 
may reasonably be expected from therapeutic measures. 

Such comprehension will enable the patients and their friends 
to second more efficiently the efforts of the physician, to appre¬ 
ciate more fully the successes which he achieves, and to judge 
more justly those cases in which his efforts are unavailing. They 
will cease to expect miracles from him, and on the other hand 
will not belittle his motives and attainments as many are too 
prone to do. The result of this better understanding will be not 


XXIX 


XXX 


PREFACE 


only gratifying to the physician, but inestimably advantageous to 
the patient. 

It is believed that an intelligent use of this volume will do 
much to bring about just such an understanding. To this end it 
has been arranged with a careful and scientific, although popular, 
treatise on anatomy and physiology, illustrated by a manikin 
which shows the relative positions of the organs and systems. 
In the second portion of the work are presented the signs and 
symptoms of most of the ills common to man, and general rules 
for treatment are given. The key-note of modern medicine is 
prevention; and special stress has therefore been paid to those 
facts which, if more widely disseminated among all classes, would 
result in a great lessening of many of the diseases now so preva¬ 
lent. No work of modern times, meant for popular use, has 
dwelt as strongly on the preventive features that are of so much 
importance; and the editors, each working in his respective field, 
have tried to set forth a correct statement of the “ ounces of 
prevention” that are worth so many pounds of cure. 

In this second part, further, may be found clear and sensible 
descriptions of disease-processes, from which the reader may really 
find out what is ailing him if he be sick. The best general road 
to recovery lies in the recognition of the illness: not in the cheap 
and meaningless directions to take some of this medicine or some 
of that, but in the essential truths of hygiene and right living. 
The giving of medicines, if they are worth anything, is a serious 
matter; and hence there is little drugging in these pages. The 
actions of remedies, however, are described as briefly as is con¬ 
sistent with the accepted facts of materia medica; and the indica¬ 
tions for dosage are laid down in conservative terms. Throughout 
the work great care has been taken to exclude anything which, 
by those prone to reckless self-medication, could be interpreted 
as an encouragement in that direction, and it seems reasonable to 
expect that the patent-medicine evil will be materially reduced by 
the realization of the limitations of drug-action which is fostered 
by The Standard Family Physician. 












PREFACE 


XXXI 


Special attention is called to the article on Pain, where, by 
means of charts, the chief pain-producing diseases are accurately 
located. A careful study of this article, with its excellent illustra¬ 
tions by Dr. Erwin Reisman, will prove of great service in 
locating and diagnosing an illness. Such study will also convince 
one how difficult it may be to determine the existing disorder, 
and how essential it becomes for the physician to learn from his 
patient the exact location and character of his pains. Close 
observation by one who has read this chapter will prove of im¬ 
mense value to both physician and patient when they meet pro¬ 
fessionally:—to the physician in that it renders his diagnosis more 
certain and thus saves useless medication; to the patient in that 
he is spared unnecessary drugging, and in that no time is wasted 
in the process of “finding out what is the matter.” 

Special articles of merit are largely to be credited to the 
members of the associate staff, one of whom has unfortunately 
been taken from us. Many of the articles on Surgery were care¬ 
fully revised by the late Dr. George Ryerson Fowler of 
Brooklyn, and this recognition is made for his valuable services. 
Further thanks are due to the persevering and painstaking efforts 
of Mr. Frank Cramer who has rendered incalculable service in 
preparing the matter for the press, and in superintending that 
portion of the publication. To the liberal policy of the Funk 
and Wagnalls Company, and for their courteous cooperation, 
we are further greatly indebted. 




















THE FAMILY PHYSICIAN 


In case of sickness there is nothing that will impart such a sense of com¬ 
fort and confidence, even in moments of great anxiety, to both the patient 
and his family, as the presence of a physician in whom they place confi¬ 
dence, who makes them feel instinctively that, come what may, everything 
will be done for the patient that trained intelligence and sympathetic skill 
can dictate. On the other hand, the realization that he is the object of 
such confidence enables the physician to do his part more effectively, to 
put forth his best efforts against the disease that he is striving to combat. 

Unfortunately such ideal relations between the physician and those who 
employ him are not always realized. There is no class of persons more 
frequently the subject of mistaken estimate than physicians. Some are 
prone to regard them as possessed of superhuman powers, and consequently 
demand miracles of them; while others adopt a suspicious and guarded atti¬ 
tude, under the idea that a doctor thinks of nothing but his fees and that 
most of the special knowledge which he claims is empty pretense. Both 
these mistaken estimates are disastrous to the physician, since he who is 
looked upon as a magician may eventually be misled to attempt the impos¬ 
sible; and even the man who is truly devoted to his science may ultimately 
lose his ideals if always regarded as a charlatan. 

Neither of these mistakes on the part of the public is justifiable. 
Physicians are human, and subject to the same variations of character 
and intelligence as other persons. But it is fair to assume that most 
persons who study medicine have an aptitude for practising it. One is 
not likely to adopt so arduous a profession unless he is urged by a genuine 
preference for it. 

The qualities most desired in a physician are honesty and a strict sense 
of duty. The man who possesses these qualities will be as good a physi¬ 
cian as his talents will permit, and will do for his patients all that lies in 
his power. There are few physicians who are not anxious to do for their 
patients all they possibly can, and results are limited by their power and not 
by their willingness. 

But, serious as are the physician’s responsibilities toward his patients, 
there are equally important duties of the patient toward the physician. 
One of these is concerned with the financial aspect of the matter. It is a 
fact often noted that “the doctor is the last man paid.” In many instances 
those who employ him are all too prompt to take advantage of the ethics of 
his profession which forbid him to refuse his aid to those in need of it; 

xxxiii 





XXXIV 


THE FAMILY PHYSICIAN 


and the bad debts on the doctor’s account-book invariably include not only 
those who can not pay but many who do not wish to pay. There are very 
few doctors who would refuse help if consulted by persons without means. 
Probably no other class of men give so freely and generously of the time and 
skill and knowledge which are as truly their stock in trade as are the goods 
of the merchant. It is all the more to be deplored, therefore, that any lax 
sense of responsibility should be manifested toward them by those who can 
afford to pay for their services. The large majority of practitioners depend 
upon their profession for the support of themselves and of their families; 
and it is the height of injustice to expect them to play the role of public 
benefactors to families who would not expect charity from any one else. 
This disposition to take advantage of the profession is annoyingly mani¬ 
fested in the cities where free medical service is provided at various clinics. 
It is a well-known fact that well-to-do persons frequently apply at these 
clinics, and so work a double injustice: toward the poor who ought to have 
the time taken up by these persons, and tow r ard the doctors who should be 
employed by them. 

It is probable that much of the lack of fairness and consideration evinced 
toward physicians is due to mere thoughtlessness. Many fail to reflect 
that the physician has a right to claim a proper interest on the money which 
he spent on the education that makes his services desirable, and that he 
must provide not only for the present necessities of those dependent upon 
him, but also for the time when his health and vigor shall decline and his 
w r ork come to an end. 

The word “cheap” has a double meaning; and those who look for a 
cheap doctor are apt to get cheap service, the last thing in the world that 
they are disposed to put up with. A physician is something more than a 
tradesman, and can not afford to quote “wholesale prices on a large order 
of goods,” as some of his patients seem to expect of him. Each separate ex¬ 
penditure of time, skill, and energy costs him equally much, and no number 
of repetitions can justify a demand for a reduced price. 

In many cases where a physician is employed by a lodge or similar 
organization, there is a tendency to overburden him with work and to reduce 
his fee to a minimum. These organizations also admit to membership per¬ 
sons who are well able to pay regular fees, and permit them to make use of 
the lodge physician. Frequently, also, individuals in good circumstances 
will form sick-funds in ordei to get medical advice cheaply. Such arrange¬ 
ments are made possible by the fact that the supply of physicians exceeds 
the demand. This state of affairs, however, tends to correct itself; and 
as a consequence of the severe competition for a livelihood now existing in 
the profession, fewer men are taking up the study of medicine. This dimi¬ 
nution in the number ot medical students will benefit not only the profession 
but also the public at large; for cheap advice is seldom the best advice, 




THE FAMILY PHYSICIAN 


XXXV 


and the imperative necessity of gaining some sort of livelihood under 
adverse circumstances is apt to have a deleterious effect on the quality 
of a physician’s work. 

In contrast to the conditions alluded to in the foregoing, many families 
maintain with their physician the most admirable relations, based upon 
well-warranted respect and mutual friendship. 

Some families have no regular physician, but call in any one who is 
convenient in time of sickness. There are obvious disadvantages con¬ 
nected with this mode of procedure. An intimate knowledge of the pecu¬ 
liarities of a family, the previous ailments of its members, etc., is of great 
value, and can be acquired only by the family physician. It is always 
imperative that the attending physician be given an accurate and detailed 
account, and that nothing be concealed which might prove of importance. 
It will be easier to confide in a physician who is called in regularly, than in 
a stranger. The former will have a higher sense of responsibility, his rela¬ 
tions to the entire family will be more intimate, he will often be able to 
arrive at a diagnosis more quickly, and he will make allowance for pecu¬ 
liarities and idiosyncrasies of the family. On the other hand, a physician 
called in but once finds himself in an altogether different position. He 
usually takes into consideration only the details of the present case, makes 
his diagnosis accordingly, and orders the necessary treatment. It is quite 
possible that the advice given is such as can be carried out only with great 
sacrifice, although a knowledge of the family circumstances might have 
enabled him to make it practicable with very slight changes. Because the 
physician is a stranger, however, the family does not feel free to explain 
the situation, and its members keep to themselves their distress at hearing 
the physician order some course of treatment which the patient’s means will 
not permit. This is only one aspect of the matter in which the regular 
family physician has the advantage over the one casually summoned, and 
others will readily suggest themselves. In small towns a frequent change 
of physicians is often occasioned by the fact that all the local practitioners 
are known to their neighbors who, for social or business reasons, may wish 
to favor all alike. 

In large cities competent specialists are frequently called for particular 
emergencies. It requires, however, considerable medical knowledge to 
determine in which cases a specialist is required, and to decide this belongs 
to the sphere of the family physician. Specialists are highly desirable, 
since certain methods of examination and treatment demand a skill and 
experience which can be acquired only by exclusive devotion to a limited 
branch of medicine; but only a physician who is versed in the entire domain 
of the profession is competent to decide as to the necessity for a specialist 
in a given case. In lodges such decisions are commonly made by the lodge 
physician. 




XXXVI 


THE FAMILY PHYSICIAN 


If possible a physician should be chosen before his services are required, 
and should be instructed in all details pertaining to the patient s habits, 
etc. The question of fee should also be settled, since otherwise it may give 
rise to misunderstandings. Once the physician is engaged, his advice 
should be scrupulously followed even before illness has set in, since much 
can be accomplished toward the prevention of disease. Hygiene, the 
science of the cause and prevention of disease, has advanced of late years 
with such mighty strides that observance of its rules is even more effective 
than the actual treatment of the disease. 

Measures to stay the course of an affection become less effective as it 
advances. It is therefore desirable to resort to medical aid at the beginning 
of a disease, even if the symptoms do not appear alarming. By doing so 
the patient may appear overanxious, but it will frequently enable him to 
avoid a serious outcome. If the doctor is notified early he will not only 
succeed better with his treatment, but will economize energy himself. If, 
for instance, he is informed in the morning that his presence is desired, he 
can divide his work better and make his more urgent calls first; whereas a 
hurry-call later may not find him at home, and he may have to travel long 
distances unnecessarily, and end by making but a hasty visit. 

This practise of prompt appeal to the doctor will also do away with 
many of the night-calls which are such a tax upon a physician’s energies 
and endurance. It is extremely inconsiderate, even cruel, to call out a 
physician at night unnecessarily. Sudden emergencies certainly do arise 
in which this is necessary; but often the decision to summon the physician 
is reached at night merely because an illness, perceptible in the morning 
but seeming at that time trivial, has failed to improve, or even, as often 
happens toward night, has become more serious. It is in such cases that 
an earlier summons to the physician would spare him much unnecessary 
exertion, and the friends of the patient considerable alarm and anxiety. 
No physician resents a really imperative night-call, and it is better to make 
ten unnecessary visits than to refuse aid in one case where it is really needed; 
but it rests with those who employ the physician to use consideration and 
good sense in this matter. 

On the other hand, although it is not advisable to ignore the first symp¬ 
toms of disease, a physician should not be troubled with too trivial matters. 
Nothing is more annoying than such foolish demands, and he who too often 
misuses the services of a physician may find them denied him at a critical 
moment. 

The troubles of a physician begin when he is confronted with a really 
serious disorder. If he does not diagnose the case promptly, his ability 
may be questioned; if, on the other hand, fearing to lose prestige by delay, 
he makes a hasty diagnosis which developments compel him to change a 
little later, the distrust engendered by this mistake will be even greater. 






THE FAMILY PHYSICIAN 


XXXVll 


As soon as the diagnosis is established, the prognosis of the disease 
begins to worry the relatives, and in many cases they insist that the physi¬ 
cian tell them in advance every detail of the course. It is perhaps but 
natural that their anxiety, working with their sense of the doctor’s superior 
knowledge, should tend to make them demand the impossible of him, but 
a little common sense and reflection should convince them of the folly and 
unfairness of so doing. 

In protracted illness friends are often consulted, and such consultations 
are fraught with peril to the physician and his patient, since remedies are 
suggested and criticisms made with a freedom in no way restricted by utter 
ignorance of the subject. In this way distrust of the physician is fostered, 
which, if continued, may result in the calling of another physician or in a 
demand for a consultation. In either case the attending physician should 
be informed of the action taken. In case a second physician is to continue 
the treatment it is desirable that the first attendant formally transfer the 

t 

case to him. A knowledge of the previous history is indispensable to the 
latter, and will prevent mistakes that might easily occur if he took charge 
of the case without knowing its previous course and treatment. Further¬ 
more, it is the height of folly and unfairness to consult some one else behind 
the back of the regular attendant. Contradictions, often more apparent 
than real, will arise and cause confusion in which the patient’s relatives do 
not know which to trust and end by distrusting both. Secrecy can rarely 
be maintained for long; and it may easily happen that both physicians 
will refuse, with perfect justification, to continue the treatment when they 
discover the real state of affairs. 

In protracted diseases it may frequently seem as if the knowledge and 
skill of the physician has been exhausted without obtaining the wished-for 
cure; and it is under such circumstances that patients are apt to turn to so- 
called “natural healers” who promise a cure unconditionally. The term 
“natural healer” is a good advertisement, since all look upon nature as the 
most able physician, and all who pursue the study of medicine spend years 
in seeking inspiration from natural processes. It need therefore cause no 
surprise that one who claims to cure under the direct auspices of nature 
will attract patients. An investigation of the character of natural healers, 
however, generally discloses the fact that they are laymen who claim to cure 
diseases without the necessary scientific foundation and without scientific 
methods of treatment. They have recourse to only a small number of rem¬ 
edies, and one can tell in advance of what their treatment will consist, since 
no attention is paid to the character of the disease. One might as well 
choose any one of the mineral waters and drink it; it may be good for 
many conditions and even for the present illness, but it may also do harm. 
Even the most innocent remedies administered in this irresponsible fashion 
may do harm if for no other reason than that valuable time is lost during 




XXXV111 


THE FAMILY PHYSICIAN 


which the disease, without proper treatment, is passing from a curable to an 
incurable stage. 

Occasionally the physician is required, not to treat a patient, but merely 
to fill out a medical certificate. Many look upon this as a mere form, and 
can not see that it need matter to the physician whether the contents of 
the certificate are true or not. Yet no one who respects and confides in a 
physician should expect a dishonesty of him as a favor. It would seem 
sufficiently obvious that such lack of scruple is incompatible with the very 
qualities that make a physician trustworthy and safe. 

These are only a few of the varied phases appearing in the relations 
between physician and patient. It is impossible to discuss all of them in 
this place, but enough has been said to indicate that the essentials of those 
relations are founded on a basis of mutual esteem, good-will, and confidence. 




THE STANDARD FAMILY PHYSICIAN 


STRUCTURE AND FUNCTIONS OF THE 
HEALTHY HUMAN BODY 

I.—INTRO DUCTION 

4 t 

Owing to the fact that scientific research proves more and more that the 
entire mechanism of our mind is altogether dependent upon our body, it need 
not surprise one that the general public is gradually awakening to the fact 
that a healthy and well-developed body is absolutely essential for both 
physical and mental work. The layman may already have found diversion 
in psychology and philosophy, but he is now beginning to recognize that the 
study of his own body is equally as interesting and profitable. 

And indeed, what is more interesting than a clear account of the struc¬ 
ture and function of the human body? The importance of this knowledge, 
even for men who are not physicians, has already been recognized in earlier 
times by some of the foremost intellects. It is well known that Goethe, 
the most celebrated poet of Germany, studied anatomy in Strasburg for two 
years. As a youth, the well-known German philosopher Herder was also 
enthusiastic about anatomy. Even rulers have taken great interest in this 
science and devoted considerable time to it; it is only necessary here to men¬ 
tion Louis XIV., Alexander of Russia, Queen Christina of Sweden, and 
Frederick III. of Denmark. The value of a knowledge of the human body 
for the painter and sculptor was emphasized as early as the middle ages by 
such important artists as Leonardo da Vinci, Raffael, Michelangelo and 
others; and to-day hardly anyone will question the benefit derived by art 
from the study of anatomy. 

But even for ordinary practical life, a certain knowledge of the human 
body seems indispensable. Everybody who wishes to live according to the 
rules of hygiene should have a general idea of the structure of the human 
organs and of their relation to the entire system. The pressure of a finger, 
applied properly upon an injured blood-vessel, may succeed in saving a 
human life. Even a layman may give valuable assistance in such common, 
every-day injuries as fractures, sprains, and contusions, by applying a tem¬ 
porary dressing or by alleviating the pain of the patient until the physician 
arrives. Everything pertaining to health will remain a secret forever unless 
there is some knowledge of the structure of the interior of the body and the 
workings of the organs. 



2 


THE STANDARD FAMILY PHYSICIAN 


II.—CHIEF CONSTITUENTS OF THE HUMAN BODY 

In the first half of the last century, the microscope was perfected so far 
that the finer structures of vegetable and animal matter could be studied. 
The botanist Schleiden first made the sensational discovery that all vegeta¬ 
ble matter is made up of a multiplicity of units, so small as to be invisible to 
the naked eye. This applies to the leaf of a plant as well as to its shoot; 
to the blade of grass as well as to the trunk of a tree. Since each one of 



these units bears a ceitain resemblance to the cells of the honeycomb, the 
name cell has been applied to them. This cell is not, however, a cavity 
filled with air, but consists of the following parts: i. The cell-membrane, 
which is composed of the true woody substance (cellulose) in plants, and 
in different plants it may be of varying thickness. 2. The cell-albumin, or 
protoplasm, the chief constituent of the cell, in which the vital processes 
take place. 3. The nucleus, a firm body embedded in the protoplasm, 
which plays an important role in the reproduction of cells. The changes 
which convert the mother-cell into two daughter-cells are first observed here. 

That the body of man and of animals consists of cells just like the 
plant, was discovered somewhat later by the anatomist Schwann. The 
earliest stage in the development of man is the human ovum, whose size is 
that of a grain of sand and whose component parts, corresponding to those 
of the plant cell, are: 1. A rather thick cell-membrane. 2. A finely granular 
protoplasm, the so-called yolk, which contains 3. A rounded body, the nu¬ 
cleus (see big. 3). Like all other cells, the human ovum eventually divides 
into two cells, and these, undergoing further division, finally give rise to 
a group of cells from which the human body develops. 

Though the body is also made up of structures not cellular in nature 
(ground-substance, fibers, granules and fluid), the cells are nevertheless 
the most important, since the vital processes of the body occur within them. 
The other structures must be looked upon as secretions of the cells, or as 
resulting from a collection of cells, as in the case of muscle- and 
fibers. 


nerve- 











3 


CHIEF CONSTITUENTS OF THE HUMAN BODY 


The human body thus forms a community of cells in which every one 
performs a certain function, like every man in a well-regulated community. 
Thus the nerve-cells of the brain and spinal cord are chiefly concerned 
with mental acts, such as thinking, feeling, etc.; the muscle-cells gene¬ 
rate force. Cells of the salivary and gastric glands secrete digestive fluids 


Cell nuclei about 
the ovum. . 



Volk. 


Membrane 
(chorion, amnion). 


Ovum nucleus. 


Fig. 3. Human ovum in the ovary. 

which are of the greatest importance for digestion. To a certain extent, how¬ 
ever, every cell is an independent organism, just as each member of a com¬ 
munity preserves his independence despite his working to a common end 
with his neighbors. An individual cell may thus become diseased and may 
even undergo destruction while the surrounding cells still enjoy full vitality. 
But as soon as many cells in one particular organ are affected, the functions 
of the entire organ will be seriously interfered with. It is possible that too 
many or too important organs of the human body may be thus affected, so 
that the entire system is so seriously injured that death results. 

The shape of animal cells varies considerably. They may be round, 
cuboid, polygonal, or even disk- or star-shaped. No matter what the shape, 
the three chief parts (protoplasm, membrane, and nucleus) can always be 
detected. In young cells, however, the membrane may be poorly developed 
or absent entirely. 

The size of cells also fluctuates within wide limits. The yolk of an ordi¬ 
nary egg is to be looked upon as an exceptionally large cell. Each single 
grain of the spawn of fish is a single cell, but each cell of the human body 
is too small to be seen without a microscope, with the exception of the 
human ovum, which is about as large as a grain of sand and can just be 
seen with the naked eye. The vegetable cells known as bacteria (bacilli, 
micrococci, etc.) are exceptionally small cells which can only be seen dis¬ 
tinctly if the magnifying power has reached a thousand diameters. Many 
play an important role as the cause of infectious diseases (the comma bacillus 
in cholera, the tubercle-bacillus in consumption, etc.; see Bacteria). 








4 


THE STANDARD FAMILY PHYSICIAN 


The vital activity of cells, already referred to, manifests itself chiefly, 
(i) by the exchange of fluids; in other words, the absorption and excretion 
of certain substances, and (2) by evidences of motion, common to the pro¬ 
toplasm of many cells. 

Exchange of fluids is carried out as follows: The cell attracts certain 
chemical principles from the fluid which surrounds it; these are then modi¬ 
fied as in a chemical laboratory, and whatever is not necessary for the build¬ 
ing-up of new tissue or for nourishing the cell is again cast off. In this 
respect every single cell behaves like a more complex animal which also 
takes in substances of which a part is used and the remainder excreted. 
It is difficult, however, to observe these processes in the cell itself; yet when 
an organ consisting almost exclusively of cells, such as the liver, elaborates 
large amounts of fluid—in the case of the bile—the inference is certainly 
justified that each single cell also secretes bile. 

That the cell really possesses vitality is much better demonstrated by the 
presence of motion. With certain cells of the human body this may be seen 
directly under the microscope. There are certain cells in the blood, the so- 
called white corpuscles (see Fig. 23), which behave in many ways like cer¬ 
tain lower animals. They can change their shape, send out processes, 
engulf certain small bodies, and travel large distances through the body so 
that they may even leave the system altogether. The so-called ciliated cells, 
which line the human air-passages, also show signs of motion. They are 
called ciliated because they are beset with fine hairs (cilia) which give 
evidence of extremely active motion. It is through them that small parti¬ 
cles of dust, etc., which have entered the air-passages, are again passed 
out. The muscle-fibers which result from the union of separate cells also 
possess motility, since they may contract and again relax. All these 
phenomena prove clearly that every cell is a small, living organism, which 
will manifest its vitality in different ways, depending upon the work allotted 
to it in the human system. 

A cement-substance, which is found here and there between the cells, 
forms a sort of embedding mass for the latter. It is not present in the early 
stages of growth, but is excreted later by the cells. In bones this cement- 
substance is very hard, owing to the presence of the salts of lime. In other 
tissues it may be soft, tough, or even elastic. One may even look upon the 
blood as consisting of cells which float in a liquid ground-substance. The 
fibers which occur in the human body may originate like muscle and nerve- 
fibers by the union of apposed cells, or else are enclosed in the ground-sub¬ 
stance, like the connective-tissue fibers to be described later. 

Granules may be found in the human body both within and without the 
cells. Little is known of their chemical composition, except that they usu¬ 
ally consist of albumen or fat. Pigment granules may also belong to the 
normal elements of the human body. They, too, may be enclosed within the 




TISSUES OF THE HUMAN BODY 


5 


cells or lie external to them. The color of the skin, hair, or eyes depends 
upon types of these granules. 

Quantitatively, water is the most important constituent of the human 

body, even when we exclude fluids like perspiration, saliva, and urine, which 
must be regarded as excretions. Fluids, like blood and lymph, that form 
an integral part of the body itself are, however, present in such large quan¬ 
tities that they constitute as much as 80 per cent, of the entire body-weight. 
It follows that if a human corpse dries up completely or becomes mummi¬ 
fied, it will lose four-fifths of its weight. 

The fluids are all albuminous solutions, containing different salts. The 
most important are (i) the blood, and (2) the lymph. The former is char¬ 
acterized by its red color; it circulates in a closed system of tubes, the so- 
called blood-vessels, while the lymph is clear as water and saturates all the 
tissues of the human body. Eventually, however, the lymph also collects in 
certain vessels which unite with each other and finally join the largest ves¬ 
sels in the form of two trunks of considerable size. 

III.—TISSUES OF THE HUMAN BODY 

If a certain number of the elementary structures already described unite 
to form one whole, it is spoken of as a tissue, even though the elements are 
not necessarily interwoven, but often merely lie side by side. Five different 
kinds of tissue may be recognized in the human body: (1) Epithelial tissue; 
(2) Connective tissue; (3) Muscle tissue; (4) Nerve tissue; and (5) 
Blood and Lymph. 



Fig. 4. Pavement epithelium of the skin. 


1. Epithelial Tissue is characteristic in that it consists exclusively of cells 
which are so closely in contact that only a very small amount of cement- 
substance is interposed. The epithelial cells form thick or thin plates 
(pavement epithelium; see Figs. 4 and 5), or upright cylinders (cylindrical 
epithelium; see Fig. 6), which are provided in certain places with fine hairs 
(ciliated epithelium; see Fig. 7). In addition to the above, the cells may 
occur in various other shapes. 

Pavement epithelium occurs in more than one layer and is found, among 
other places, upon the surface of the human body. Cylindrical epithelium 







6 


THE STANDARD FAMILY PHYSICIAN 


lines the interior of many cavities, such as the stomach and the intestines, 
while ciliated epithelium clothes the inner surface of the larger part of the 
respiratory tract. In all these instances the epithelial layer forms a protec¬ 
tion for the tissues lying underneath it; and as soon as there is a break in 
the layer, the latter are exposed to injury. The epithelial cells also form an 
integral part of the glands of the human body, where they serve to elaborate 
the secretions. 

The term gland is applied to every organ which secretes certain substances 
necessary for the proper function of the body. Thus, there are salivary 
glands, gastric glands, mucous glands, sweat glands, sebaceous glands, the 



Superficial pave¬ 
ment epithelium. 


Middle layer of 
rounded cells. 


Deep cylindrical 
layer. 


Fig. 5. Epithelial layers in the skin, cross section. 


liver, the pancreas, etc., and the name generally indicates the nature of 
the secretion. The most primitive type of a gland is a simple tube, the 
inner surface of which is lined with epithelial cells (see Fig. 8). The se¬ 
cretion formed by the latter empties upon the surface in the direction indi¬ 
cated. The so-called simple glands cannot be seen with the naked eye, but 
require the use of a microscope. It happens, however, that many of these 
tubes unite and discharge their secretion into a common excretory duct. In 
this case the term “compound gland” is used (see Fig. 9). If many of these 
ducts, like the tributaries of a stream, unite in forming a large, common duct, 
a gland of this type may form an organ of great size. The liver and kidneys 
may be mentioned as the largest glands of the human body. The lymph- 
glands should not be confused with these true glands. They are better 
known by the laity, since when inflamed they swell and form large nodes 
which are readily seen and felt. They do not, however, secrete in the true 
sense of the word and are not supplied with excretory ducts. 

2. The term “Connective Tissue” includes many tissues which serve to 
support or to embed various organs of the human body. The group includes: 
(1) Connective tissue proper; (2) Fatty tissue; (3) Cartilage; and (4) 
Bone, 









TISSUES OF THE HUMAN BODY 


7 


(i) Connective Tissue proper also consists of cells, but these are very 
small and insignificant and are embedded in a large amount of ground- 
substance which is characterized by a remarkably fibrous structure. These 



Fig. 6. Cylindrical epithelium. Fig. 7. Ciliated cells. 


connective-tissue fibers are generally arranged in bundles or larger bands. 
Two chief varieties are found in the human body—loose and firm connective 
tissue. 

In loose connective tissue the separate fibers or bundles are arranged in 
wider meshes, like a mass of woolen thread (see Fig. io). It is therefore 
more elastic and can be displaced more readily, and hence is found where 
certain organs are movable upon each other. Wherever the skin can be 



Fig. 8. Simple gland. Fig. 9. Compound gland. 


easily picked up in folds, loose connective tissue is present; and a certain 
amount is placed between the different muscles, so that these can easily 
contract without friction. Loose connective tissue forms a light-gray mass, 
which can also be seen in the red meat (muscle) of animals. Owing to its 
lax condition it may be easily distended with air, by blowing through a fine 
tube. This was formerly practised by butchers, in order to improve the 
appearance of meat. 

* In firm connective tissue, the fibers are placed side by side like the 
threads in a piece of cloth, or else are firmly interwoven. The consistency is 





























8 


THE STANDARD FAMILY PHYSICIAN 


much firmer. Examples are the tendons, whose fibers run parallel (see Fig. 
n), the various ligaments which hold together the bony frame-work, and 
the different membranes of the human body. The latter, however, form a 
network, more or less firm, whose fibers frequently run in all directions. 
The corium, pleura, pericardium, peritoneum, renal capsule, and the mem¬ 
branes of the brain belong to this group. 

When either loose or firm connective tissue is boiled in water, the fibers 
swell up and dissolve to a jelly-like mass, known as gelatin or glue. 
This process also goes on during the boiling and frying of articles of food; 



Fig. io. Loose connective tissue. 



Fig. ii. Fibrous connec¬ 
tive tissue of tendon. 



Fig. 12. Elastic fibers in connec¬ 
tive tissue. 


and the solidification of the juice as it leaves the meat is caused by the 
formation of gelatin. The glue used in the industries is also manufactured 
by boiling organs rich in firm connective tissue, such as hoofs and horns of 
cattle. The action of acids on connective-tissue fibers is similar to that of 
boiling, since swelling and solution will eventually take place. Meat is often 
placed in vinegar or sour milk in order to soften the fibers, and thus render 
the meat more readily digestible. Frequently the connective-tissue fibers 
are accompanied by the so-called elastic fibers. These retain their strength 
and elasticity, in fact are not altered at all by boiling or by the action of 
acids. They also differ in appearance from the usual connective-tissue 
fibers, since they are always net-shaped (see Fig. 12). 

(2) Fatty Tissue is really nothing but connective tissue in whose cells 
large amounts of fat have been deposited, so that they appear round like 
cannon-balls (see Fig. 13). When fresh, the color of fatty tissue is white or 
pale-yellow. It is chiefly of value to the animal body in that it forms a re¬ 
serve deposit of nourishment whenever the normal supply of food is cut off 
for any length of time. Most wild animals store up large amounts of fat dur- 






































































































































TISSUES OF THE HUMAN BODY 


9 


ing the summer, which serve as food for the winter when the normal supply 
is less abundant. This is especially well seen in the hibernating class. An¬ 
other valuable property of fat is its poor conductivity of heat,which prevents 
too active dissipation of heat from the organs which lie underneath it. 
Even in men with good development of the muscles, a certain amount of fat 

Nucleus. 



Fig. 13. Fatty tissue, the nuclei showing in some cells. 


under the skin is of decided advantage during the cold season. Stout indi¬ 
viduals will feel the cold less intensely than those with less fat; on the other 
hand they will suffer more from the heat of summer since the excess of heat 
from their own bodies cannot so readily find an outlet. Finally, the fat acts 
as a soft cushion or support for delicate organs which would be easily in¬ 
jured by pressure or blows of any kind. Thus the kidneys are embedded in 
layers of fat; and the eye proper lies in a soft cushion, which fills up the 
entire orbital cavity. Should the fat accumulate excessively either within or 
outside of the organs, the symmetry of the body will be interfered with, and 
the organs themselves (as the muscles) may suffer since their tissues will be 
compressed and destroyed. 

(3) Cartilage appears like porcelain with bluish-transparent shimmer. 
Besides a certain amount of firmness, it possesses also ductility and flexi¬ 
bility. As in other tissues, cells are also found here, but these are embedded 
in a firm, translucent ground-substance. Cartilage is found throughout the 
body wherever a certain amount of firm support is required, without loss of 
ductility. A good example is the tip of the nose. This w T ould break or 
change its form more readily if the partition between its two halves con¬ 
sisted of bone instead of cartilage. The skeleton of infants during the first 
years of life is also in great part cartilaginous; for this reason they may fall 
while attempting to walk without readily sustaining a fracture. In adult 
life the front ends of the ribs remain of cartilage, so as to facilitate the move¬ 
ments of respiration. The ends of the bones which enter into the formation 
of joints are covered with cartilage, the smooth surface of which reduces 
friction to a minimum. It may happen that this cartilaginous layer is lost 
with advanced age, in which case the bones will rub against each other. It 






10 


THE STANDARD FAMILY PHYSICIAN 


is for this reason that old people so frequently complain of stiffness and pain 
in the joints. The elasticity and ductility are more marked if many elastic 
fibers are embedded in the ground-substance, as in the cartilage of the ear. 

Even if stretched or distorted to a 
marked degree, this will again resume 
its original shape. See Fig. 14. 

(4) Bone, despite its firmness, 
also consists of cells, characterized 
by being star-shaped with many pro¬ 
jections which connect each cell with 
its neighbors (see Fig. 15). The 
ground-substance in which these cells 
lie is of stony hardness owing to the 
presence of large amounts of phos¬ 
phate and carbonate of lime. These 
salts may be extracted by placing the 
bone in an acid such as muriatic acid. 
What remains behind will still retain 
the original shape, but will be more flexible and less resistant, like cartilage. 
In that peculiar disease of children, known as rickets, the deposit of lime- 
salts in the bones is deficient, or absent altogether. The numerous con¬ 
sequential disturbances 
are described more care¬ 
fully under Rickets. 

The dense network of 
blood-vessels found 
everywhere in bone is 
known as the system of 
Haversian canals. 

3. Muscle is found 
in the human body in 
two forms: (1) Striated 
Muscle; and(2)Smooth 
Muscle. The chief ele¬ 
ments are the muscle- 
cells or fibers which arc 
peculiar in that they contract and shorten. 

(1) Striated Muscle is nothing but the red meat of animals employed as 
food. Under the microscope, it is seen to consist of fibers, known as muscle- 
fibers, showing an occasional nucleus and a delicate cross-striation (see 
Fig. 16). A striation may also be observed with the naked eye, since the 
fibers are arranged side by side in bundles which are separated by a con¬ 
siderable amount of loose connective tissue. Connective-tissue fibers are 




Section of blood- 
' - vessel with blood- 
cells. 



Bone cells. 


Fig. 15. Bony tissue. 



Capsule. 


Nucleus. 


Protoplasm. 

Ground-sub- 

stance. 


Fig. 14. Cartilage cells slightlv contracted and 
separated from the ground-substance. 













TISSUES OF THE HUMAN BODY 


11 


muscle nucleus 


iarcolemma 


thin layer of 
muscle substance 


retracted ends 
of muscle- 


also found between the individual fibers. If much firm connective tissue is 
present in a muscle, the meat will be tough and hard when prepared. At 
both ends of a muscle the fibers change into tendon fibers. 

Every single striated muscle-fiber 
possesses the property of contracting 
under the influence of the will. As a re¬ 
sult the fibers will appear thicker and 
shorter, and the two tendinous ends will 
approach each other. Since the tendons 
are almost always fixed to some bone, 
it follows that the bones will also be 
approximated as the muscle contracts, 

(see Figs. 17 and 18). All active mo¬ 
tions of the skeleton have their origin in 
a contraction of muscle-fibers. 

A number of other irritations besides 
our own will may bring about a contrac¬ 
tion of striated muscle-fibers. If a severe 
blow be directed against a muscle, it will 
harden, and an involuntary twitching 
may be observed which results in a 
movement. The same thing will happen if a strong electric current is 
passed through the muscle. Both forms of irritation (the physical manip- 



Fig. 16. Striated muscle. 




Fig. 17. Muscles of the upper 
arm at rest. 


Fig. 18.' Muscles of the upper 
arm contracted. 


ulation massage and electrical stimulation) are employed in medicine to 
strengthen weak and flabby muscles. 

(2) Smooth Muscle-Tissue is made up of long, spindle-shaped cells, 
which may also be so arranged as to form bundles. They are called smooth, 








































I 


12 THE STANDARD FAMILY PHYSICIAN 


since the individual cells do not exhibit any cross-striping as in the case of 
striated muscle. To the naked eye, however, this form of tissue does not 
appear smooth, but fibrous. The fibers which frequently fall out of the 
stomach of a goose which is cut open after being cooked for a long time are 
bundles of smooth muscle-fibers. They are abundant also in the human and 
animal uterus, and also in other organs, as in the walls of the stomach and 
intestines. Their function here is to propel the food onward. In the walls 
of the urinary bladder, the smooth muscle-fibers serve to discharge the urine, 

if this organ is filled. The smooth muscle- 
fibers are frequently arranged in a ring-shaped 
manner, as about the pupil of the human eye. 
When light falls upon the eyes, contraction will 
narrow the pupils. Ring-shaped fibers also play 
a very important role in the blood-vessels of the 
human skin. Their contraction will here narrow 
the vessels, and diminish the amount of blood 
carried to the skin, since less fluid will pass 
through a narrow than through a wide tube in 
the same space of time. Frequently a ring of 
smooth muscle serves to close off a cavity so that 
the contents are not discharged. A good ex¬ 
ample is the anus. 

Striated muscle is always under the control 
of our volition, and its contractions result from 
an impulse from the brain. Smooth muscle, on 
the other hand, is not influenced by our wills. It 
may even contract against our wills, as in the case 
of stomach cramps or painful diarrhea. Striated 
muscle shows fatigue readily, but smooth muscle 
may remain in a contracted condition for a long time, or even continuously, 
without showing any ill effects. Certain drugs (lead-water, tannic acid, etc.) 
can bring about a contraction of smooth muscle-fibers; while others, as 
opium, relax them. The same can be said of different degrees of tempera¬ 
ture. During cold weather, the smooth muscle-fibers in the vessels of the 
skin will contract so that the skin appears pale. A temperature of about 
ioo° F. will relax the fibers, as a consequence of which the skin will 
redden. If still higher degrees of temperature act very suddenly upon the 
skin a lapid contiaction follows. This is well seen in the so-called goose- 
skin which forms in a very hot bath. 

The muscle-fibers of the heart occupy an intermediary position between 
striated and smooth muscle-fibers. They possess striation, but contract 
without or against our will. 

4. Nerve-Tissue consists chiefly of the nerve or ganglion cells, which are 



Fig. 19. Smooth muscle-fibers. 
a an isolated muscle-cell,^muscle- 
cells in a bundle. 





















TISSUES OF THE HUMAN BODY 


13 


connected among themselves and with the different organs of the body by 
means of fine fibers, so-called nerve-fibers, which serve to conduct the im¬ 
pulses from cell to cell. 

Nerve or ganglion cells occur in large numbers, almost solely in the cen¬ 
tral organs (brain and spinal cord). They form comparatively large cells 
with distinct, vesicular nuclei. Their shapes vary, but generally they ap¬ 
pear star-shaped owing to the presence of a larger or smaller number of pro¬ 
jections. Each one of these projections passes over into a delicate fibrous 
process which either communicates with other nerve-cells or passes through 
the body, to end in some organ. The nerve-cells are the seat of the intel¬ 
lectual life of man. Volition and imagination, and the processes of thinking 
and perceiving, originate within the nerve-cells and are dependent upon 
them. If all the nerve-cells of the human body suddenly ceased to function¬ 



ate, all intellectual life would come to an end at the same moment; but if 
only some of them were destroyed, only that part of mental activity which re¬ 
sided in the destroyed cells would be lost. There are also nerve-cells whose 
only duty it is to preside over the function of speech. The destruction of 
these cells would cause the individual to lose his ability to speak. It is, 
however, impossible to explain how all the various psychic phenomena are 
carried out within the nerve-cells. 

Nerve-fibers possess a cylindrical shape, but are more delicate than 
muscle-fibers (see Fig. 21). They are the continuations of the processes of 
the nerve-cells, and are in reality a part of them, nerve-fiber and nerve-cell 
together making what is known as a nerve unit or neuron. Their course is 
through brain and spinal cord; after they leave these organs they unite with 
others to form thin or thick strands, and course through the body, to end 
finally in some viscus. The nerve-fibers may thus be likened to wires car¬ 
rying messages from the brain and spinal cord to the various organs of the 
human body. The brain and spinal cord may be regarded as central sta- 
















































14 


THE STANDARD FAMILY PHYSICIAN 


tions, the nerve-fibers as the telegraph wires which run from them to the 
smaller sub-stations, the organs of the body. At their exit from the brain 
or cord the nerve-fibers are united into fine or coarse bundles which pass 
through certain openings in the skull or vertebral column, and then break 
up, first into larger, and then into finer branches which are too small to be 
seen with the naked eye in the organs themselves. They end there in cer¬ 
tain end-apparatuses, such as the tactile corpuscles of the skin, or the nerve- 
end-plates of the muscles which are here described. 



Fig. 22. Showing the course of the nerve-fibers between the nerve-centers and the end-organs. 


The nerves and nerve-fibers may be classified as follows, according to the 
organs in which they terminate: (i) Motor Nerves; (2) Secretory Nerves; 
(3) Sensory Nerves; and (4) Nerves of Special Sense. 

(1) Motor Nerves terminate in muscle. Before a certain muscle con¬ 
tracts, the impulse to do so originates in one or more nerve-cells of the brain. 
This impulse then travels downward through certain nerve-fibers, finally 
reaching the corresponding muscle which responds to the stimulus by con¬ 
tracting (see Fig. 22). These motor nerves can never transmit a sensation 
back to the brain; their sole function is to induce muscular contraction. 

(2) Secretory Nerves are those that end in a gland and control its secre¬ 
tion (see Fig. 22).. If a dog smells food, one can easily observe how the 
saliva gathers in his mouth. The perception of a welcome morsel here acts 
upon the brain as a stimulus which is then carried through certain nerve- 
fibers to the salivary gland, increasing the activity of the gland-cells. The 
secretory nerves are likewise unable to transmit sensations of pain, the 
stimulus traveling only in one direction; namely, from the brain to the gland. 































TISSUES OF THE HUMAN BODY 


15 


(3) Sensory Nerves serve solely as carriers of sensations from some point 
of the body to the brain (see Fig. 22). The impulse, therefore, must travel 
in a direction opposite to that of motor or secretory nerves. If the skin is 
pricked, the stimulus travels, by way of special nerve-fibers, up through the 
spinal cord to the brain where it gives rise to the sensation of pain. Sensa¬ 
tions of taste, heat, cold, motion, etc., are conveyed to the brain in like 
manner. 

(4) The Nerves oj Special Sense , which are also particular sensory nerves, 
likewise convey impulses to the brain where the impressions received by the 
special senses are recorded. Thus the light-waves received by the eye, or 
the sound-waves which reach the ear, stimulate the corresponding nerve- 
endings, and are thereupon transmitted, by way of the optic or auditory 
nerves, to the brain, where they enable the process of seeing or hearing to 
take place. 

It follows from the above that every special nerve-fiber can transmit only 
one special form of stimulus. The optic nerve may be cut through without 
giving rise to pain; the individual operated upon merely receives the sensa¬ 
tion of light, If a pain-carrying nerve be divided, a sensation of pain is the 
result; while the division of a motor nerve gives rise to a twitch in the muscle 
supplied by this nerve. The severance of a glandular nerve is followed by 
a transient, increased activity of the corresponding gland. 

Electrical currents or chemicals have exactly the same effect as mechani¬ 
cal irritations, such as cuts, blows, or contusions. If a motor nerve be moist¬ 
ened with some caustic fluid, the result will be a muscular twitch. Warmth 
and cold can also irritate or even paralyze the nerve-fibers to a marked 
degree. An individual sitting against a cold draft may thus acquire a 
complete paralysis of that half of the face which is directly exposed to the 
current of cold air. Severe chilling of sensory nerves may also give rise to 
painful rheumatic conditions. 

5. Blood and Lymph may also be classified among tissues even though 
it may seem strange that a fluid should be called a tissue. Microscopical 
examination, however, shows that we are here dealing with cells which are 
suspended in a fluid ground-substance. 

Blood is enclosed in a system of branched tubes, known as the blood¬ 
vessels. The amount of blood in the human system is less than one would 
assume. Taking an adult individual of medium size, the total quantity 
corresponds to about eleven to thirteen pounds. The cells of the blood are 
termed blood-corpuscles; the fluid, blood-plasma. The latter constitutes a 
dilute solution of albumen containing other substances, such as salts, either 
temporarily or permanently. The blood-corpuscles may be divided into 
two classes, the red and the white cells. 

The red cells give rise to the characteristic color of blood. With a high 
magnifying power they appear as very small, round disks whose surfaces are 





16 THE STANDARD FAMILY PHYSICIAN 


hollowed out like the discus used by the ancient Greeks (see Fig. 23). There 
are about 5,000,000 red blood-cells in a cubic js of an inch. Their average 
diameter is yttw'o an i nc h* The red cells are important elements of the 
blood since they are the carriers of hemoglobin, the specific red coloring- 
matter of the blood, which contains a certain amount of iron. This hemo¬ 
globin possesses the property of attracting the oxygen from the air, which 
gives it its bright red color. This process goes on in the lungs during res¬ 
piration. The red corpuscles absorb oxygen from the air inhaled as they are 
propelled through the minute vessels of the lung. The cells then carry the 



Fig. 23. Blood-cells. 

R red blood-corpuscles^ WL lymphocyte, WE eosinophile, WP polymorpho-nuclear leucocytes. 

oxygen to the various organs where it is passed over to the tissue-cells and 
utilized to build up organs or to generate animal warmth. The highly im¬ 
portant function of the red blood-cells for the animal economy is thus 
evident. Life will cease at once if the body no longer receives its supply 
of oxygen. General disturbances soon set in if an individual has too 
small an amount of red blood-coloring matter, as in chlorosis or anemia, the 
coloring matter present being insufficient to secure the necessary amount of 
oxygen for the organs. 

The colorless or white blood-corpuscles (see Fig. 23, W E, W L, W P) 

are larger in man than the red cells (^VVo i nc h)> but are much less 
abundant. Normally one colorless corpuscle goes with 300 to 400 red cor¬ 
puscles. When resting, or deprived of vitality, they are round; but under 
normal conditions they frequently behave like snails in that they send out 
and draw in projections of their protoplasm, and frequently they change 
their position by means of these projections so that they may travel over a 
considerable distance within the human body. They may even migrate out 
of the body in certain excretions like mucus or saliva. They possess the 
property of drawing themselves out so that they may pass with considerable 
force through openings which are invisible under the microscope even with 
high magnifying power. The yellow fluid generally known as pus is made 








TISSUES OF THE HUMAN BODY 


17 


up chiefly of these migrated white blood-corpuscles. Expectorated mucus, 
if tinged yellow, also contains many of these elements. Another important 
property of these peculiar cells is their power of engulfing or “ devouring ” 
small bodies such as granules of pigment, bacilli, etc. Since such cells may 
also wander out of the body, the system, and with it the various organs, is 
thus able to rid itself of certain harmful substances. Owing to this property, 
the white cells have frequently been termed the “ guards of the human body.” 

The blood-plasma, or fluid in which the cells just described are sus¬ 
pended, possesses the important property of clotting as soon as it leaves the 
vessels. If an artery of a living animal be opened and the blood be caught 
in a vessel, one may observe that it gradually turns more viscous and jelly- 
like. A little later a reddish clot, the blood-coagulum, becomes separated 
from a more yellowish fluid, the blood serum. The blood-coagulum con¬ 
sists of red corpuscles, enclosed in a peculiar fibrous substance known as 
fibrin. If freshly discharged blood be beaten up during the process of clot¬ 
ting, the fibrin will collect upon the beater in the form of tough fibers which 
exhibit a grayish-white color if washed. 

Clotting in an injured blood-vessel is in every way analogous to clotting 
outside of the body in a glass receptacle. The process leads to the forma¬ 
tion of a clot of the same composition as here described, which, by closing 
up the opening in the injured vessel, causes the bleeding to cease, since no 
more blood can leave the vessel. It seems that in certain individuals who are 
predisposed to spontaneous bleeding (“ bleeders see Hemophilia) the 
blood does not possess the normal power of clotting, and it may be very 
difficult to stop even slight hemorrhages from insignificant wounds. Such 
people may bleed to death after trifling wounds. 

If the blood-pressure is high within a blood-vessel, a clot will form less 
readily and the bleeding cannot be checked so easily. It is for this reason 
that clotting does not occur in the larger arteries of the body, and an injury 
to these vessels will be fatal if no physician is at hand. If a patient swoons, 
a serious hemorrhage may cease spontaneously, the weakened action of the 
heart reducing the blood-pressure so considerably, even in the larger vessels, 
that a clot may form. 

Lymph in a pure condition is also a watery solution of albumen, in which 
a few cells, the so-called lymph-corpuscles, are suspended. These do not 
differ from the colorless blood-corpuscles, and lymph may thus be regarded 
as blood minus the red blood-cells. Pure lymph is found in the blisters 
which form on the feet after wearing tight shoes, or in the palm of the hand 
after gymnastic exercise, or from burns or caustic applications. Within the 
body, the lymph constantly exudes from the blood-vessels, bathing all tissue- 
spaces between the latter. It finally collects in small, delicate vessels, the 
lymph-vessels, which unite into larger ducts. These finally join the blood¬ 
vessels not far from the heart. Small organs known as lymph-nodes or 





18 


THE STANDARD FAMILY PHYSICIAN 


lymph-glands, and varying in size from a pea to a bean, are interposed in the 
course of the lymph-vessels in various localities of the human body. They 
behave like filters by retaining certain injurious substances (poisons, bacilli, 
etc.) which may have contaminated the lymph. As a consequence, the 
lymph-nodes may inflame and swell up to the size of a walnut, or larger, so 
that they can be easily felt through the skin. Inflamed lymph-nodes may 
also suppurate so that an incision will be necessary. It has been already 
stated that the common term “lymph-gland” is a misnomer. 

The relation between blood and lymph may be explained by the follow¬ 
ing example: The blood circulates in a closed system of tubes like the drain¬ 
age pipes of a farm. The lymph may be compared to a fluid permeating 
the soil between the tubes. Small openings in the tubes then establish 
a communication between the water in the tubes and that of the soil. 

IV.—THE HUMAN SKIN 

The chief function of the human skin is to act as a protection for the 
organs which it covers. Its property to remove superfluous excretory prod¬ 
ucts from the body, such as certain substances contained in the perspiration 
and the sebaceous secretion, is no less important. The skin may also be 
looked upon as a kind of respiratory organ, since part of the carbonic acid 
formed in the body escapes through it. In some of the lower animals, 
respiration goes on largely through the skin. Human skin consists of three 
layers: (i) Epidermis; (2) Corium; and (3) Subcutaneous Fatty Tissue; 
and of a certain number of Accessory Organs. 

1. The epidermis is built up solely of epithelial cells (see Fig. 5). Under 
the microscope these can be seen to form two distinct layers, the Malpighian 
layer and the horny layer. Both layers are visible to the unaided eye in 
blisters, such as are made in the palm of the hand by rowing or other exer¬ 
cise; the one raised up by the fluid is the horny layer, whereas the reddish 
floor of the blister when this is incised forms the Malpighian layer. 

The deeper cells of the Malpighian layer approximate the cylindrical 
shape, but nearer to the surface the flat type prevails. All these cells are in 
a state of active growth, so that those lost upon the surface by rubbing, 
washing, etc., are constantly renewed. In the colored races, pigment gran¬ 
ules are found in the cells of the Malpighian layer, the pigment being dark¬ 
est in the black races. 

The deeper cells of the horny layer are thick and flat; but toward the 
surface they gradually become thinner, finally forming very narrow scales. 
If compared with the softer cells of the Malpighian layer, they appear as if 
dried up, yet they are considerably more resistant because the albuminous 
matter in them is converted into horny substance. Like other substances 
consisting of horny material (hair, nails, feathers), the cornified cells of the 
upper layers easily attract and retain water which softens them and causes 



THE HUMAN SKIN 


19 


them to swell. This is well demonstrated when bathing in warm water. 
Large quantities of the horny scales can be removed after the bath while 
drying the skin with a towel. And hard nails and corns are rendered so 
soft that they can be easily cut or scraped off. A certain amount of water, 
however, is always contained in the skin. If this evaporates more or less, 
the skin will turn brittle and crack easily. The largest amount of water is 
found in the skin after bathing. One may easily catch cold after a bath, 
since the evaporation of this water will remove considerable warmth from 
the body. 



Fig. 24. Cross-section of the human skin. 


Swelling and softening of the cells of the horny layer are caused to a 
much more marked degree by potash and soda lye than by plain water, the 
potash lye acting more strongly and rapidly than soda. Large quantities of 
potash are contained in the so-called black or green soap (potash soap) and 
in the yellow olein soap. Soda lye, on the other hand, enters into the com¬ 
position of many toilet soaps, and the use of any of these soaps will cause 
the cells of the horny layer to swell up and soften so that they can be easily 
removed by rubbing with a towel. Together with the most superficial cells, 
the dirt adhering to the skin will also come off. In order to cleanse and dis¬ 
infect the body thoroughly, it is necessary to resort to potash soap from 
time to time. Neutral or fatty soaps, however, are better for individuals 
with sensitive skin, particularly since potash soap is frequently manufac¬ 
tured from refuse (see Skin, Care of). 

The epidermis contains few blood-vessels. In certain localities, vessels 
apparently can be seen in the skin, but merely because the epidermis is 
transparent where it is thin. The red color of the skin depends upon the 









































20 


THE STANDARD FAMILY PHYSICIAN 


amount of blood in the vessels, as well as upon the thickness of the epider¬ 
mis. If the vessels are empty, the skin will be pale. A certain degree of 
thickness on the part of the epidermis is of advantage, since the skin will 
be less sensitive and will become inflamed less readily. 

2. The corium, which can be seen if the epidermis be removed, has upon 
its surface a number of conical or wart-shaped projections known as the 
papillae of the skin. Microscopically, these consist of a densely interwoven 
network of connective-tissue fibers with many elastic fibers. The latter 
give the skin its elasticity and permit it to return to its normal condition after 
it has been raised up in a fold. The corium of some animals plays an im¬ 
portant part in the industries, since it is converted into leather by being 
treated with certain substances rich in tannic acid (specifically, oak-bark). 

The corium contains both vessels and nerves. Some of the nerves end in 
the papillae by means of peculiar cone-shaped structures, known as the 
tactile corpuscles, because they are supposed to transmit the tactile sensa¬ 
tion. Others penetrate as far as the cells of the Malpighian layer where 
they end in small knobs which probably transmit sensations of pain. 

3. The subcutaneous fatty tissue lies directly under the corium, and 
consists chiefly of connective-tissue fibers in which numerous fat-cells are 
embedded. The amount of fat present is proportionate to the stoutness of 
the individual, the layer being very thick in the well-nourished. This can 
be demonstrated best by picking up a fold of the skin. In many places, 
however, the skin is always free from fat. The skin of the eyelids and ears 
invariably contains few fat-cells, and upon the back of the hands and feet 
the fold of skin raised is always very thin. 

The accessory organs of the skin include (1) the Sweat Glands, (2) 
the Sebaceous Glands, (3) Smooth Muscle-fibers, (4) the Nails, and (5) Hair. 

(1) The Sweat Glands (see Fig. 24) form long tubes whose blind ends, 
rolled up in the form of coils, extend downward for quite a distance, and may 
even penetrate to the subcutaneous fatty tissue. The inner layer of these 
tubes is generally lined by a single layer of cubical epithelial cells, which 
secrete the perspiration. In the epidermis their course resembles that of a 
corkscrew, while their opening upon the surface of the skin is just visible 
to the unaided eye as a fine point. The perspiration secreted by these glands 
consists chiefly of water and various salts. There can be no doubt, how¬ 
ever, that the sweat glands remove a number of other substances from the 
body, which cannot always be detected by chemical tests. The marked per¬ 
spiration noted during the course or at the termination of certain diseases 
possibly serves to rid the body of certain poisonous principles. Under nor¬ 
mal conditions the perspiration merely protects the epidermal cells from 
drying out, since the spiral portion of the excretory duct no longer possesses 
definite walls of its own but enters into intimate relation with the cells. The 
excreted fluid evaporates upon the surface of the skin, thereby removing 





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PLATE I. —MUSCLES OF THE HUMAN BODY 

(From the front) 


1 . 

Sternoclidomastoid 

12. 

Long extensor of toes 

2. 

Trapezius 

13. 

Long extensor of the great toe 

3. 

Pectoralis major 

14. 

Platysma myoides 

4. 

Biceps 

15. 

Deltoid 

5. 

Triceps 

16. 

Flexors of upper arm 

6. 

Abductor pollicis (muscles of thumb) 

17. 

Flexors of forearm 

7. 

Abductor of little finger 

18. 

Extensors of the arm 

8. 

External oblique of abdomen 

19. 

Anterior muscles of the hip 

9. 

Sartorius (tailor-muscle) 

20. 

Flexors of the thigh 

10. 

Quadriceps extensor 

21. 

Extensors of the thigh 

11. 

Anterior tibial 

22. 

Extensors of the foot 


23. Lumbrical 

muscles 

of the toes 


(For description of the functions of the various • muscles, see pp. 42-47. 

also index to the manikin) 


✓ 


See 

















THE HUMAN SKIN 


21 


considerable warmth from the body. It follows that a cold may be caught 
most readily after the body has perspired freely. 

(2) The Sebaceous Glands (Fig. 24) are much shorter, and possess a 
more acinose (cluster of grape-like) structure, because they widen out at 
their blind ends. The inner layer is also lined with epithelial cells which 
secrete a solid and soft, fatty substance known as the sebaceous matter of 
the skin. This renders the hairs and the surface of the skin supple, and 
protects against excessive evaporation of water. The inhabitants of certain 
parts of Central Africa grease their skin with animal fat because the extreme 
dryness of the air causes an excessive evaporation of water from the skin. 
Most sebaceous glands lie close to the hairs, so that the latter are anointed 
by the sebaceous matter even before they have grown out of the skin. 
The normal gloss of the hairs depends chiefly upon the fat with which they 
are supplied. Large sebaceous glands without hairs are found in certain 
localities of the human body, such as the forehead and nose. Excretory 
ducts, too, are generally filled with sebaceous matter which readily exudes 
if pressure is exerted upon the skin. If the skin of the nose be squeezed, a 
small worm-shaped body will appear at the opening of the sebaceous glands; 
this body, which is often looked upon as an animal parasite, gives rise to 
blackheads. If this vermiform body be rubbed up between the fingers, its 
fatty nature will be evident. The sebaceous glands occasionally become 
obstructed when inflammation sets in, and the surrounding skin will turn 
red. The red noses of some individuals are caused by obstructed and in¬ 
flamed sebaceous glands. It is wise to press out the obstructed sebaceous 
glands from time to time, after thorough cleansing, when these disagreeable 
conditions appear. 

(3) Smooth Muscle-Fibers occur in the human skin about the small 
blood-vessels, and also as the “erector muscles” (Fig. 24) of the hairs. The 
smooth muscle-fibers of the blood-vessels have been already discussed. 
Their contraction diminishes the diameter of the blood-vessels so that less 
blood will circulate through the skin and this will appear pale. Their re¬ 
laxation increases the supply of blood and the skin will redden. The erector 
muscles of the hairs run obliquely from the end of the root of the hair to 
the line of junction between epidermis and corium. By their contraction 
the hair is raised and drawn slightly out of the skin. The skin will then 
appear to be set with small conical projections, forming the so-called “goose- 
skin.” Contraction can readily be brought about by a cold douche, and 
application of cold water has quite properly been termed a sort of gymnastic 
exercise for these fibers. The same action results from an “air-bath.” 

(4) The Nails are horny plates which are pushed forward during their 
growth on verv delicate longitudinal furrows of the subcutaneous tissue. 
The part of the skin which supports the nail is called the “nail-bed”; the 
horseshoe-shaped furrow into which the edge of the nail fits, the “matrix” 



22 


THE STANDAND FAMILY PHYSICIAN 


of the nail. The most posterior portion of a normally shaped nail forms a 
white, crescent-shaped spot. This spot appears white because the blood¬ 
vessels of the corium are less numerous there than in the more anterior por¬ 
tions of the nail. A portion of the epidermis generally projects over the 
white area. Owing to its exposed position, this dries out and cracks easily, 
giving rise to the so-called “hang-nails.” These should not be neglected, 
since dirt may easily get into the small wounds, giving rise to inflammation 
of the fingers (see Nails, Care oe). 

(5) The Hairs are merely cornified appendages of the skin. They are 
derived from epithelial cells of the epidermis, which become horny while still 
in the deeper layers, and then penetrate the surface. The root of the hair, 
however, extends down in the corium for quite a distance and may even 
approach the subcutaneous fatty tissue. The part of the hair contained in the 
skin is the .root; its f,ree portion, the shaft. In untrimmed hair the shaft ends 
in an extremely fine point. The lower end of the root of the hair forms a 
nodular swelling (the bulb of the hair), which is hollowed out like the false 
bottom of a bottle. In this bulb the proliferations of the epidermal cells 
take place, which are responsible for the longitudinal growth of the hair. 
The excavation of the corium which receives the roo*t is known as the hair- 
follicle. The sheath of the hair-root is the layer of epidermal cells which is 
continued into the follicle so that it surrounds the hair on all sides like a 
sheath. If a loose hair be pulled out, the sheath frequently remains adher¬ 
ent to the root in the form of a transparent pellicle which can be easily pulled 
off. The hair itself consists chiefly of cornified spindle-shaped cells con¬ 
taining a varying amount of pigment in dark hairs. Blond hairs are also 
pigmented, but the pigment is so finely distributed that it no longer appears 
in the form of granules. Gray or white hairs either contain no pigment at 
all, or else are split up owing to the presence of numerous cracks and fissures 
between the horny cells, which are filled with air. Gray hairs alone are not 
always a sign of age, since many individuals near thirty are completely gray. 
The sudden change of color seen after severe emotions, such as fright, is 
also due to this splitting (see Hair, Care of). 

In the newly-born, the body is covered only by very delicate hairs known 
as the lanugo hairs. A part of these fall out at an early age and are replaced 
by permanent hairs such as are found upon the scalp, the eyebrows and eye¬ 
lids, the axilla, etc. But the life of these hairs is also limited, since they fall 
out and are replaced by new hairs. Under normal conditions each hair of 
the head has a life history of several years. The daily growth is about 
of an inch, and the ultimate length from \ to 1 yard. Excessive falling 
out of the hairs is generally due to an affection of the scalp, or to anemia. 
Exhausting infectious diseases such as typhoid may also lead to baldness. 
The occurrence of isolated spots of baldness here and there is frequently 
due to parasites in the hair-follicle, the presence of which interferes with the 











GROSS ANATOMY OF THE HUMAN BODY 


23 


growth of the hairs (see Hair, Care of). It must be emphasized here that 
there is no known infallible external remedy to promote the growth of hair, 
and all claims of this kind are humbug. Frequent cutting of the hair will 
thicken each individual hair and make it appear fuller, but it cannot in¬ 
crease the actual number. Short hairs also possess the advantage that 
they and the skin from which they grow can be more readily cleansed. 

V.—GENERAL REMARKS ON THE GROSS ANATOMY OF THE 

HUMAN BODY 

The external shape of the human body differs widely with the different 
races and the members of each race. Although there are doubtless certain 
definite characteristics for each race, it must not be forgotten that there are 
well-marked exceptions. Thus, there may be negroes and Japanese witn 
pronounced Caucasian features and remarkably light skin; while on the 
other hand the white race may include individuals whose faces suggest more 
the negro type, and whose skin is exceptionally dark. 

Compared with the male sex, women are smaller and more delicate, but 
with more graceful and less angular shape. The neck, which is more slen¬ 
der, gradually passes into the rounded shoulders, while in the man the neck 
is stouter and is placed more abruptly upon the more angular shoulders. 
Despite the well-developed breasts, the female chest is more slender and 
narrow. On the other hand, the central portions of the body (hips and 
pelvic region) are better developed in women. The buttocks are very 
prominent and counterbalance the abdomen when it enlarges with preg¬ 
nancy. The lower extremities are considerably shorter than in men; the 
difference being most marked in the legs (average two inches). The deli¬ 
cate skin of women is supplied with an abundant deposit of fat which is 
responsible for the graceful contours. In the male, the true form is more 
apparent, and the body is more slender and muscular. 

The internal structure of the human body always remains approximately 
the same, no matter how the external form varies (see Fig. 25). The human 
body may be compared to two tubes, placed perpendicularly, one in front of 
the other, when the body is in the upright position. The anterior (so-called 
vegetative tube) is the wider of the two, and contains the digestive organs. 
It begins at the mouth and nose and ends at the anus. The respiratory 
organs (wind-pipe and lungs) also join this cube. 

The second, posterior tube lies in the skull and vertebral column, and con¬ 
tains the brain and spinal cord, the high development of which organs is char¬ 
acteristic for the human beings as distinguished from the animals. The two 
tubes together with their membranes form the so-called axis of the body in 
which the following parts may be recognized: (1) Head; (2) neck; (3) thorax; 
(4) abdomen; and (5) pelvis . The three last-named are spoken of collectively 
as the trunk. The body itself is supplied on each side with two appendages, 




24 


THE STANDARD FAMILY PHYSICIAN 


called limbs or extremities, which serve to bring the body into more intimate 
relation with its surroundings, and permit it to move from place to place 
The upper extremities consist of shoulder, upper arm, lower arm, and hand; 



Fig. 25. Giant, dwarf, and man of average height. 


the lower, of the hip, thigh, leg, and foot. The shoulders and hips are placed 
between the body and the extremities. 

The trunk and extremities are supported by bones, all of which together 
form the skeleton. The bones are united by joints, ligaments, or sutures, 
\\ hich will be described more in detail later. The bones are surrounded by, 
and intimately connected with, muscles which are in every way analogous to 
















GROSS ANATOMY OF THE HUMAN BODY 


25 


the red meat of animals. The chest contains the main organ of the circu¬ 
latory system, the heart, the contractions of which keep the blood within 
the body in motion. The large vessels which leave the heart are closed 
tubes which subdivide like the branches of a tree and enter almost every 
organ of the human body. Their ultimate branches are so small that 
they can be seen only under the microscope. A large number of nerves 
issuing from the brain and spinal cord also reach the organs through open¬ 
ings in the skull and vertebral column. At first they appear as coarse 
strands, but soon become more delicate and finally microscopic like the 
vessels with which they generally enter the organs, as motor, secretory, 
or sensory nerves, or as nerves of special sense. A few organs, such as 
cartilage, the solid substance of the teeth, the lens, and the vitreous humor 
of the eye, are not supplied with blood-vessels. 

In describing the separate organs of the human body, definite terms 
must be used. The natural position of the body is the upright one, and 
for purposes of clearness it is here presumed that the thumbs point out¬ 
ward, so that the palms of the hands face frontward. In this position the 
terms upward (superior), downward (inferior), forward (anterior) and 
backward (posterior) will not give rise to confusion. If the human body 
is viewed from in front, it will be evident that it consists of two parts which 
are alike in every way, but reversed. The plane which divides the body 
into these two halves is known as the median plane. Since both halves 
are alike, they are termed symmetrical. Most of the organs of the body 
also occur in pairs; those which are single (as the heart, liver, stomach, 
certain muscles, etc.) were double, or at least symmetrical, at a certain 
early stage of development. Though the body may thus be spoken of in 
a general way as symmetrical, the fact must not be looked upon as a strict 
rule. In most right-handed individuals, the right side of the body is more 
developed than the left, and in the left-handed the opposite holds true. 
And it is only in very few persons that the two halves of the face are strictly 
alike. The nose is very rarely placed in the median line, but generally 
deviates slightly to the left or right. This applies also to the classical 
statues of antiquity, accurate measurements having shown that the sym¬ 
metry of both halves of the face is only apparent. From these facts it 
was quite properly concluded that human beings were used as models in 
ancient times. 

Other terms necessary for a clear description of the human body are 
mesial and lateral. Mesial is applied to everything lying close to the me¬ 
dian plane ; lateral to everything distant from this. For example, the angle^ 
of the eye situated near the nose is spoken of as the mesial , the other as the 
lateral angle. The directions toward and awav from the middle plane 
are called respectively the mesial and the lateral direction. The terms 
internal and external were formerly used in these senses; but at present 






1 Skull 

2 Jaw-joint 

3 Vertebral joints 

4 Neck-joints 

5 Rib-joints 

6 Mid clavicle-joint 

7 End clavicle-joint 

8 Clavicle 

9 Acromion process 

10 Shoulder-joint 

11 Ribs 

12 Shoulder-blade ( scapula ) 

13 Humerus 

14 Breast-bone ( sternum ) 

15 Lumbar vertebrae 

16 Vertebral joints 

17 Elbow-joint 

18 Sacrum 

19 Hip-bone {ilium) 

20 Radius 

21 Ulna 




Fig. 26. Human skeleton (front view) 

























22 Hip-joint 



23 Head of femur 

24 Wrist-joint 

25 Bones of the hand 

26 Greater trochanter 

27 Lesser trochanter 

28 Femur 

29 Inner trochanter of femur 

30 Outer trochanter of femur 

31 Patella 

32 Knee-joint 

33 Lateral trochanter of tibia 

34 Head of fibula 

35 Inner trochanter of tibia 

36 Superior joint of fibula 

37 Fibula 

38 Tibia 

39 Inner ankle 

40 Outer ankle 

41 Ankle-joint 

42 Bones of the foot 


Fig. 27. Human skeleton (.back view). 



































28 


THE STANDARD FAMILY PHYSICIAN 


an organ is termed external if it lies nearer to the surface, and internal if 
nearer to the axis or middle of the body. Thus, the thorax has an external 
surface, covered by skin, and an internal one adjacent to heart and lungs. 

The organs of the body are generally described in the following sub¬ 
divisions: (i) Bones', (2) ligaments; (3) muscles; (4) internal organs; (5) 
vessels; and (6) nerves. Only the fundamental principles will be described 
in the following chapters. 


VI.—BONES 

All the bones of the human body taken together form a framework, 
known as the skeleton (see Figs. 26 and 27); and from even a cursory exam¬ 
ination of the skeleton it will be seen that the shape of the bones varies 
considerably. The extremities consist chiefly of long bones which possess 
a large cavity filled during infancy with red marrow and in the adult with 
yellow marrow. The short and flat bones have a more spongy structure, 
and their meshes always contain red marrow. Where the bones enter 
into a true joint they are always smooth, because they are here covered 
with an opaque, glassy surface of cartilage, the function of which has al¬ 
ready been pointed out. The bones possess many small and large open¬ 
ings which permit blood-vessels and nerves to enter and leave. Other 
peculiarities are projections and irregularities of the surface which indicate 
the sites to which the various muscles are attached. The muscles being 
generally more developed in the male sex than in the female, the muscle 
attachment places are more pronounced in the male skeleton. Further¬ 
more, the surface of every bone is covered by a thin, white and shiny layer 
of tissue (the periosteum ), which is abundantly supplied with nerves so 
that an. injury or inflammation, such as may follow a blow on the shins, 
is exceedingly painful. 

The bones are joined to each other by (1) sutures, (2) cartilaginous 
plates, (3) masses of connective tissue (false joints), or (4) by true joints. 
Sutures are found only in the skull where various projections from the 
edges of the bones fit into each other like the cogs of a wheel. The growth 
of the various bones which make up the skull goes on at these sutures, 
and if the latter become ossified prematurely no further growth is possi¬ 
ble. At an advanced age most sutures ossify normally so that it may be 
difficult to distinguish them. In the second class, two adjacent bones are 
joined by a layer of cartilage; while in false joints the junction is formed 
by a mass of connective tissue such as forms the intervertebral disks. In 
true joints, each of the two bones concerned possesses a covering of carti¬ 
lage between which is found a narrow slit (the synovial cavity ) filled with 
a small amount of stringy or gelatinous fluid (the synovial fluid ) which 
serves to lubricate the joint-surfaces. Further details of this subject will 
be found under Joints and Ligaments in the succeeding chapter. 





BONES 


20 


i* The Skull may be divided into two parts, the cranium and the jace. 
The bones of the cranium form a box-like enclosure for the brain; while 
those of the latter form the framework of the face. The strongly arched 
upper portion of the entire skull is called the vault; the lower, very irregu¬ 
lar portion, provided with many projections and openings, is called the 
base of the skull. Many bones (twenty-two in all) enter into the formation 
of the skull, and only the most important ones can be mentioned here. 
The vault is made up in front of the frontal bone; above and in the middle 


tal 


Inferior 

Maxillary 

Fig. 28. Bones of the adult skull. 

of the two parietal bones; and behind of the occipital bone, which also 
forms the most posterior portion of the base. A large rounded opening 
(the foramen magnum) is found here, through which the spinal cord passes 
into the skull to merge in the brain. The lateral walls of the skull are 
formed chiefly by the temporal bones, on the sides of which are the open¬ 
ings leading to the inner mechanism of the ear. Behind this is a projec¬ 
tion pointing downward, which is known as the mastoid process and which 
gives attachment to the strongest muscle of the neck, the sternoclidomas- 
toid. The mastoid process contains a number of cavities which com¬ 
municate with the middle ear. A purulent inflammation in the middle 
ear frequently spreads to these cavities, so that an operation may be neces¬ 
sary to open them. 


Nasal Bone 


Superior 

Maxillary 



Occ ipi 
Rone 


\ • 1 Tr External Auditory 

; Crienoid lossa Canal 
'Zygoma 











































30 


THE STANDARD FAMILY PHYSICIAN 



Spinous 
' Process 


Two prominent bones of the face are the malar bones , which are placed 
by the side of the orbits and communicate with the temporal bones by 
means of a narrow arch of bone, the zygomatic arch. The malar bones 
are generally spoken of as the cheek-bones. The two nasal bones form 
the bony framework of the nose and partly give it its shape. Beneath 
the nasal and malar bones is the upper jaw, which constitutes the greater 
part of the facial skeleton, and which contains the upper teeth. The lower 
most portion of the face is formed by the lower jaw, which consists of a 
horseshoe-shaped middle piece (the body ) from the ends of which two 
branches extend upward. These branches possess articular processes 

which connect with the 

Superior Articular , -it T 

Processes temporal bone by means 

of the temporo-maxillary 
joint. If the skull be 

viewed from in front, 

the two orbital cavities 
for the eyes and their 
accessory parts will be 
very pronounced. Be¬ 
tween these is the nasal 
cavity, which by means 
of a partition is divided 
into two halves, called the left and right nasal jossa. Three shell-like 
processes, the turbinate bones of the nose, project from the lateral wall of 
each nasal fossa. The floor of the nasal cavity is formed by the hard palate. 

2. The Vertebral Column may be regarded as a long tube, the trans¬ 
verse sections of which present a more or less rounded appearance. It is 
made up of a number of separate ring-like bones, the vertebrce. According 
to their position, these are described as (i) seven cervical vertebrce , (2) 
twelve dorsal vertebrce , (3) five lumbar vertebrce , (4) five sacral vertebrce , 
and (5) four or five coccygeal vertebrce. The twenty-four upper vertebrae 
(cervical, dorsal and lumbar) are known also as the true vertebrce , because 
they are connected with each other by means of joints and ligaments. The 
five sacral vertebrae are united to form one single bone, the sacrum , to 
which is connected the coccyx , an appendage made up of the consolidated 
four or five coccygeal vertebrae. This coccyx corresponds to the tail of 
animals. 

Every true vertebra consists of an anterior, prominent portion (the 
body ), and a posterior, narrow arch (see Figs. 29 and 30). The body and 
arch together enclose the orifice for the spinal cord and its membranes. 
The following processes arise from the arch: (a) the spinous process , point¬ 
ing backward and easily felt through the skin; (b) two transverse proc¬ 
esses directed outward; and (c) four articular processes , two of which are 


Inferior Articular 

PiKjceiies 


Fig. 29. Side view of a spinal vertebra. 























BONES 


31 


Transverse frocess 


Articular Process 


Articular Process 


directed upward and two downward. The last-named processes serve to 
form small accessory joints between adjacent vertebra. The dorsal ver¬ 
tebra possess also small articular surfaces to which the ribs are fastened. 
Among the cervical vertebra, the uppermost one, the atlas , has a peculiar 
shape, which enables it to turn with the head around a special process of 
the second vertebra, known as the odontoid process. The lowermost por¬ 
tion of the vertebral column (the so-called false vertebroe) is formed by the 
sacrum, a triangular piece of bone, the broad, upper portion of which abuts 
against the last lumbar vertebra, while its apex is directed downward. Its 
front and back surfaces contain a number of large openings which serve 
as passages for vessels and nerves. 

The lateral surfaces of the sacrum 
are connected on each side with the 
hip-bone. The coccyx is attached 
to the apex of the sacrum and hangs 
downward. All three bones together 
form the pelvis , to be described 
later. 

Viewed from the side, the verte¬ 
bral column presents four distinct 
curves (see Fig. 31). The cervical 
portion is convex anteriorly, the 
dorsal portion concave, the lumbar 
portion convex, and the sacral and 
coccygeal portion again concave. These curves are not present in the newly- 
born, but develop during the first years of life. The cervical curvature makes 
its appearance when the infant begins to hold up its head. The dorsal 
curve is a result of its attempts to sit, and in weak children it may be exag¬ 
gerated to a hunch. Walking in the upright position gives rise to the lum¬ 
bar curve; and the sacral curve is probably formed coincidentally with 
development of the pelvic organs. All the curves become more pronounced 
if heavy weights are carried upon the head or shoulders. A crouching 
posture may cause the entire vertebral column to become concave ante¬ 
riorly; but on lying down, the curves almost entirely disappear so that the 
vertebral column becomes straight and elongated, sometimes to the extent 
of an inch. A person getting up from bed after a long sickness may indeed 
be taller, because his vertebral column has straightened. 

All the changes described in the foregoing depend upon the normal 
mobility of the vertebral column. Disease may, however, affect the bones, 
so that permanent, abnormal curvatures will follow. The best-known of 
these is the lateral curvature of the spine (see Part II. s.v. Vertebral 
Column, Curvatures of), which is either the direct result of the im¬ 
properly constructed desks found in so many schools, or else is due to the 



Fig. 30. 


spinous Irocess 

A spinal vertebra seen from above. 












THE STANDARD FAMILY PHYSICIAN 


Cervical 

Curvature 


Dorsal 

Curvature 


fact that many school children carry their heavy books invariably in the 
same hand. Usually this condition is not recognized until one shoulder 
is higher than the other. Parents should carefully watch for this symp¬ 
tom and should consult a physician in time. The so-called hunch is a 
kinking or curvature backward which also, as a rule, is due to a disease 
of the spine. Unless treated early, it will lead to permanent disfigurement. 

3. The Thorax is a large cage for the 
heart and lungs. It is composed of the 
twelve dorsal vertebrae, together with the 
twenty-four ribs (twelve on each side), 
and the sternum. The sternum appears 
as a long narrow bone, which forms the 
most anterior portion of the chest and 
which can be readily felt under the skin. 
At its two upper angles it is connected 
with the two clavicles, and by means of 
its lateral edges with the seven upper ribs. 
These seven ribs are therefore called 
the true ribs; the five lower ones, the 
jalse ribs. The two lower of the false 
ribs are very short and their front ends 
lie free in the abdominal wall; hence 
they have also been termed free ribs. 
Behind, every rib is connected with the 
corresponding vertebra through the agen¬ 
cy of two small joints. Every rib con¬ 
sists of an anterior small portion, the 
costal cartilage , and a posterior, large 
one, the rib proper. The elasticity of 
the costal. cartilages greatly facilitates 
the expansion of the thorax during res¬ 
piration. If the thorax be viewed from 
the front, an angle, known as the costal 
angle , will be noticed at the lower end. 
In this place may be seen in lean individuals a depression in the abdomi¬ 
nal wall, known as the epigastric fossa , behind which are placed the stom¬ 
ach and part of the liver. By some people this region is erroneously 
associated with the heart; probably because the pulsations can be felt here 
during increased activity of the latter organ. . 

The shape of the thorax is not the same in the two sexes. In the male 
sex it is cone-shaped; that is, narrow above, and wide below. In women 
it is narrow above, broad in the middle and again narrow below, the narrow¬ 
ing of the lowest portion being almost always a result of tight lacing from 


Lumbar 

Curvature 


Sacral 

Curvature 



Fig. 31. 


The spinal column seen from the 
side. 








BONES 


33 


corsets 01 other female apparel (see Figs. 32 and 33). In women who 
have laced very tightly, one may even find the ribs kinked, turned downward 
and bent together in front, d he so-called chicken-byeast is sometimes seen 
in individuals who were rachitic during childhood. It is characterized by 
a marked forward projection of the sternum, and by a depression of the 
costal cartilages. Individuals with a tendency toward consumption often 



possess a long, narrow, and flat thorax; while those whose vocation requires 
frequent and deep respirations (laborers, mountain guides, etc.) generally 
have a short, broad, and deep (so-called “barrel-shaped”) thorax. See 

Plate XVII. 

4. The Upper Extremities consist of the following bones: (1) The clav¬ 
icle or collar-bone, (2) the scapula or shoulder-blade, (3) the humerus , 
(4) the two bones of the forearm (radius and ulna), and (5) the twenty- 
seven bones of the hand (see Figs. 26 and 27). 

The clavicle forms a sort of support placed between the thorax and 
the shoulder; and it may, therefore, break if one falls on the hands. 
The bone is always curved slightly; its mesial end is related to the 
upper corner of the sternum, its lateral end to the projecting outer 
portion of the shoulder-blade, the so-called acromion. The entire clavicle 















34 


THE STANDARD FAMILY PHYSICIAN 


can be readily felt through the skin, so that fractures may be easily 
diagnosed. 

The scapula is a flat, triangular bone, whose front surface rests against 
the back surface of the thorax. A prominent process, the spine of the 
scapula, projects from its back surface, and throughout its entire course 
it can be felt under the skin. Laterally and in front this spine ends 
in a flat process, the acromion , which stands in relation to the clavicle. 


The bone has three angles: 
two above and one below. 
The upper lateral angle 
corresponds to the articular 
surface, which, together with 
the upper end of the hu¬ 
merus, forms the shoulder- 
joint. 



The humerus is a hollow 

bone the upper end of which 
possesses a hemispherical 
protuberance, the head of 
the humerus, which articu¬ 
lates with the joint-surface 
of the scapula. The long, 
central portion is known 
as the body. The lower 
end is more triangular and 
comes into contact with 
the two bones of the fore¬ 
arm by means of a layer 
of cartilage. The two prom¬ 


Fig. 34. The bones of the hand from the back. 


inent corners, easily felt under the skin, are the mesial and lateral con¬ 
dyles of the humerus. 

The bones of the forearm are two in number, the one corresponding to 
the side of the thumb being termed the radius; the second one, on a line 
with the small finger, the ulna. At its upper end the ulna presents a hemi¬ 
spherical hollow into which the humerus fits. The uppermost portion of 
the ulna behind this hollow is the elbow or olecranon process. Through¬ 
out its entire course the ulna may be felt under the skin, while the greater 
part of the radius is covered by muscle so that only the lower end is acces¬ 
sible to the examining fingers. 

The hand (see Fig. 34) is divided into three parts: (1) The root; (2) 
the middle portion; and (3) the fingers. The root of the hand is made 
up of eight small bones of different shape; four of these form an upper 
row and four a lower one. Passing from the side of the thumb, the four 

















BONES 


35 


bones of the upper row are termed, according to their shape, the scaphoid 
bone, semilunar bone, cuneiform bone, and pisiform bone; those of the 
lower row, the trapezium bone, trapezoid bone, os magnum , and unciform 
bone. The middle portion of the hand consists of the five metacarpal bones. 
Of the fingers , four are made up each of three bones or phalanges; while 
the fifth, the thumb, consists of only two phalanges, the middle one being 
absent. The root and central portion form the real firm support of the 
hand, while the fingers possess considerable mobility. 

5. The Lower Extremities include the following bones: (1) The hip¬ 
bone; (2) the femur or thigh-bone; (3) the two bones of the leg ( tibia and 
fibula ); and the bones of the foot (see Figs. 26 and 27). In early life 
the hip-bone consists of three distinct and separate bones, the ilium, 
ischium , and pubis. The 
ilium forms the upper 
excavated portion, known 
also as the iliac fossa. 

The ischium and pubis 
enclose an oval opening, ^ ^ ' 

which is covered by a p ube5 _ 

membrane. The lower¬ 
most portion of the is- ^ c< - tabu l uml 

Orxluralor 

chium is the tuber ischii Foramen 

which supports the weight Tuberojlt , of tsc u™' / 

* - - Symphysis rube 



Anterior Superior 
Spine of Ilium 


Anterior Inferior 
' 5pine of Ilium * 


.Arch 


Pubic Spine 


Fig. 35. Male pelvis seen from in front. 


of the body when in the 
sitting posture. The two 
pubic bones are united in front by means of the pubic symphysis. Below 
this is the pubic angle, which is more rounded in the female than in the 
male. 

Together with the sacrum and coccyx, the two hip-bones form a bony 
ring, the pelvis. The three parts which make up the pelvis are so firmly 
united that only slight mobility is possible. The pelvis as a whole may 
be said to consist of two parts, the true and the false pelvis. The true 
pelvis is situated between the two iliac fossae, and is open in front; it is 
separated from the false pelvis by a curved line, the iliopectineal line , which 
marks off the inlet of the pelvis, an opening which is rounded in women 
but more heart-shaped in men. The portion of the pelvis beneath the 
inlet is the false pelvis; and the opening limiting this below, the outlet of 
the pelvis. 

The male and female pelves differ considerably; in fact, the difference 
between the male and female skeleton is most prominent here. All diame¬ 
ters of the female pelvis are larger; the inlet is more rounded, and the 
pubic angle more curved. The expanded portion of the ilium is steeper 
in man; while in the woman it is more flat and hence placed further out- 










the standard family physician 


36 


ward, which explains why the hips are more prominent in the female 
sex. 

The femur is the strongest hollow bone ot the human skeleton. Its 
upper, ball-shaped end, known as the head, joins the central portion, or 
body, at an obtuse angle by means of the neck. At this locality there are 
two large protuberances, of which the lateral is called the great, the mesial 
the small trochanter. To these processes are attached almost all the mus¬ 
cles which turn the thigh in or out (around its long axis). The lower end 



Fig. 36. 


Pubic Arch 

Female pelvis seen from in front. 


of the femur terminates in two prominences, the mesial and lateral tuber¬ 
osities of the femur, which, together with the patella and the tibia, form 
the knee-joint. The patella is a triangular bone which is placed entirely 
within the tendon of a strong muscle (the quadriceps extensor; see Fig. 

45). The upper ends of the 
femur are considerably further 
apart than the lower, so that the 
legs of every human skeleton are 
x-shaped. 

The two bones of the leg are 

termed tibia and fibula. The for¬ 
mer is the larger, and its sharp 
edge (the shin) is located just 
beneath the skin and therefore 
much exposed to injury. The 
upper end of the tibia presents 
two prominences which, in harmony with those of the femur, are called 
the mesial and lateral tuberosities of the tibia. The central portion 
is the body; and the lower end shows a blunt prominence (the mesial 
condyle) which points downward. The fibula is a very slender bone, 
whose upper end, the head, does not enter into the knee-joint. Its central 
portion, the body, is covered by muscles; its lower end forms a more prom¬ 
inent process, the lateral condyle, which also points downward. Both con¬ 
dyles form a depression which receives the uppermost bone of the foot, 
the astragalus. Both the upper and the lower end of the fibula can be easily 
felt through the skin. 

The bones of the foot (Fig. 37) are divided like those of the hand into 
three classes, viz: (1) The root of the foot, or tarsus; (2) the central por¬ 
tion of the foot, or metatarsus; and (3) the toes. The root forms the most 
posterior portion of the foot and includes seven short bones, viz: the astrag¬ 
alus, the calcaneum, and the scaphoid, cuboid, and three cuneiform bones. 
The astragalus occupies the highest position, and forms a joint with the 
fork formed by the two bones of the leg. It rests upon the calcaneum, the 
most prominent bone of the foot, which also forms the back of the heel. 
The bones of the tarsus are joined with those of the metatarsus, which 







BONES 


37 


Phalanges 


Metatarsal 
; bones 


Cuneiforms 


Scaphoid 


Cuboid 


latter correspond to the metacarpal bones, but exceed them in length. 
The toes have exactly the same number of phalanges as have the fingers; 
and the terms first, second and third phalanx are applied to the different 
joints. Like the thumb, the great toe lacks the middle segment. All the 
phalanges of the toes are considerably shorter than those of the fingers, 
and are often imperfectly developed. In the hand, the third or middle 
finger exceeds the others in 
length; but in the foot, the 
second toe is the longest. 

Deformities of the lower 
extremities are very frequent 
because their bony frame¬ 
work is not always strong 
enough to carry the weight of 
the body. Such deformities as 
x-shaped legs (bandy legs), or 
o-shaped legs (bow legs) fre¬ 
quently persist in adult age. 

They are often seen in individ¬ 
uals who at an early age have 
been forced to carry heavy 
weights or to stand much on 
their feet (as blacksmiths, 
waiters, etc.). In bakers, one 
limb is often normal while the 
thigh and leg of the other 
limb form an obtuse angle di¬ 
rected outward. This is caused 
by the peculiar position assumed 
when bread is placed in the oven; and the deformity may involve the right 
or left limb, according to which hand is used. Most deformities, however, 
result from rachitis during the first years of life (see Part II. s.v. Rachitis); 
but if the curvature during childhood is not severe, it may disappear as the 
child grows up. Deformities also frequently affect the skeleton of the 
foot owing to improper footwear. Shoes with high heels and pointed toes 
are most injurious, the weight of the body crowding the toes into the pointed 
end, so that they may even be caused to overlap each other. The great 
toe shows the effects more than the others, and generally deviates strongly 
toward the side of the small toe. 

Other common deformities are flat jeet and club jeet. The normal 
skeleton of the foot forms an arch so that the inner border of the foot ap¬ 
pears hollow and the foot rests upon the heads of the metatarsal bones and 
the posterior end of the calcaneum (heel). In flat jeet (see Figs. 38 and 


Astragalus 



Heel 


Os calcis 


Fig. 37. The bones of the foot. 















38 


THE STANDARD FAMILY PHYSICIAN 





a O C u 

Fig. 38. Foot impressions, a, normal foot outlines; b, c, d, flat-foot impressions. 


39) the entire sole, including the inner edge, rests upon the ground. In 
club jeet all the bones are underdeveloped and forced together into a club- 

shaped mass; this condition is generally 
congenital. 



Fig. 39. Flat foot. 


VII.—JOINTS AND LIGAMENTS 

It has already been shown (p.28) that 
two bones which enter into a true joint (see 
Fig. 40) are covered with cartilage where 
they press against one another. A small 
amount of glairy fluid (the synovial fluid) is 
found between the two cartilaginous surfaces, and serves to lubricate them. 
Under normal conditions, the quantity corresponds to the amount of oil nec¬ 
essary to lubricate two parts of some machinery which move upon one an¬ 
other. The slit which contains the synovial fluid is known as the synovial 
cavity , and is closed off from the outside by means of the joint-capsule 
which is smooth inside and fibrous outside, and which encloses the two 
ends of the bones like a sheath. Occasionally, however, a larger quantity 
of fluid accumulates in the Synovial cavity, causing the joint surfaces of 
the bones to separate and the synovial membrane to swell. The tearing 
of a ligament may cause blood to flow into the synovial cavity and fill it. 
In inflammation of a joint, the synovial cavity may contain a large amount 
of watery (really albuminous) fluid, or a yellowish, purulent matter. Aside 
from the pain caused by the presence of this fluid, the activity of the joint 
is seriously impaired. 

The motions possible in a normal joint depend to a great extent upon the 
shapes of the joint-surfaces, which vary considerably in the human body. The 
freest motion of all is possible in ball-and-socket joints in which one sur¬ 
face corresponds to the section of a hollow sphere, the other to that of a 






















JOINTS AND LIGAMENTS 


39 


Ligament 


Join 4 Cavity 


Synovial 
. Membrane 


.Capsular 

Ligament 


solid sphere. The ball-and-socket joints of machinery are also capable of 
motion in every direction. In hinge-joints, fhe joint-surfaces possess a 
cylindrical shape and the motion is similar to the opening and closing of 
a knife. Of the various other varieties of joints mention shall be made 
only of those with level surfaces, in which only slight motion is possible, 
because the bones can be displaced but slightly in a lateral direction. An¬ 
other factor which determines the mobility of a joint is the condition of 
the capsule. If the latter is relaxed and easily stretched, the joint may 
become so loose that the bones move to and fro; and individuals whose 
joint-capsules are excessively stretched 
are frequently exhibited in dime mu¬ 
seums. Lastly, the mobility of a joint 
depends also upon the accessory liga¬ 
ments present. These are either very 
dense portions of the capsule itself, 
or else are placed external to the lat¬ 
ter in the form of prominent masses c ?pJU ]ar_ 

of connective tissue which run between 
two bones. On stretching, these lig¬ 
aments soon become tense, thereby 
preventing too great a separation of 
the bones. In certain joints the in¬ 
terior of the synovial cavity is likewise 
supplied with such bands. The most 

important joints of the human body rlG 40 ^ ong sectlon tnrougn a 
are the following: cavity 15 much unified. 

1. The temporo-maxillary joint is an articulation between the con¬ 
dyle of the lower jaw and the articular surface of the temporal bone of the 
skull (see Fig. 28). The chief motions are upward, downward and later¬ 
ally. When the mouth is opened very widely, the articular surface of the 
lower jaw slips out of the glenoid cavity in the temporal bone with a for¬ 
ward motion. This can be easily demonstrated by placing the finger in 
front of the ear while opening the mouth. Yawning, or a severe blow on 
the lower jaw may cause the articular surface to be displaced forward so 
far that the mouth can not be closed again without medical assistance. 

2. The joints of the vertebrae are situated between the articular sur¬ 
faces of the different vertebrae. In addition to these, the vertebrae are 
connected also by the invertebral disks and certain accessory bands which 
are placed between the adjoining bones. The lateral rotation of the head 
takes place in the so-called odontoid joint, located between the odontoid 
process of the second, and the arch of the first cervical vertebra. 

3. The articulations of the ribs are divided into anterior and posterior 
joints. The anterior or costosternal articulations are placed between the 



Fig. 40. Long section through a joint. The 













40 


THE STANDARD FAMILY PHYSICIAN 


anterior ends of the seven true ribs and the sternum. Posteriorly, the 
ribs are connected with their corresponding vertebrae by means of two 
small joints. All these joints permit the raising and lowering of the ribs 
during breathing. 

4. The joints of the upper extremities include various articulations. 

The clavicle is in relation with the sternum and the acromion by means 
of the sternoclavicular and the acromioclavicular articulations respectively. 
The former permits the raising and lowering of the shoulder, as well as its 
forward and backward movements; while the motions of the shoulder- 

blade are carried out in 
the latter. The shoulder- 
joint (see Fig. 41) is placed 
between the articular sur¬ 
face of the scapula and the 
head of the humerus, and 
being a ball-and-socket 
joint it permits of free mo¬ 
tion in every direction. Up¬ 
ward motion beyond the 
horizontal plane is, how¬ 
ever, impossible, because 
the humerus easily presses 
against the acromion. If it 
is desired to raise the arm 
still higher, the shoulder 
must be rotated so that its 
lower angle moves outward. Other arm motions possible in this joint 
are movements away from and toward the body, forward and backward 
movements, and inward and outward rotations. 

The elbow-joint (see Fig. 42) is situated between the lower end of the 
humerus and the upper ends of the two bones of the forearm. The only 
motions possible here are the bending and stretching of the forearm. The 
two bones of the forearm are connected above and below by means of pivot- 
joints which enable inward and outward turning of the forearm and the 
hand. During outward rotation the radius and the ulna lie side by side, 
and the palm of the hand is directed forward; during inward rotation the 
radius is placed in front of the ulna so that the two bones cross at an acute 
angle, and the back of the hand is directed forward. It should not be 
forgotten that in all these movements the radius always corresponds to 
the side of the thumb, and the ulna to the side of the little finger. The 
wrist-joint permits free motion of the hand forward, backward, inward and 
outward. The joints placed between the carpus and the metacarpal bones 
show only slight mobility; but the motion between the metacarpals and 


Capsule of 
shoulder- 
joint 


Humerus 


Deltoid 

muscle 



Scapu 


Fig. 41. The shoulder-joint. 

















JOINTS AND LIGAMENTS 


41 


the first phalanges is fairly free. The different phalanges of each finger 
are connected by means of true hinge-joints which allow only flexion and 
extension. 

5. The joints of the lower extremities likewise include several forms. 
Both hip-bones are connected in front through the pubic symphysis (see 
Fig. 44). This is a false joint consisting only of firm connective tissue 
which does not permit of any motion. True joints are found between the 
sacrum and each hip-bone, but the motion here is also very slight since 
strong ligaments cover the joints behind. The bones of the pelvis thus 
form a very firm ring. One of the most important ligaments of the pelvis 
is Poupart's ligament which runs from the upper 
anterior spine of the ilium to the spine of the 
pubis. It is placed exactly between the region of 
the abdomen and that of the thigh, and beneath 
it are placed the large blood-vessels for the lower 
extremities. 

The hip-joint is a very freely movable joint and 
its capsule is perhaps the strongest in the human 
body, although it has been known to tear in dis¬ 
locations. The chief motions of the hip-joint are 
flexion , by which the thigh is raised against the 
abdomen; extension , whereby the thigh forms a 
straight line with the body; abduction , by which 
the thighs are separated from one another; adduc¬ 
tion, whereby the thighs are brought together; and 
rotation inward and outward around the long axis 



of the thigh. Fig. 42. Elbow-joint from in 

Femur, tibia and fibula form the knee-joint 
(see Fig. 45), the capsule of which is also very dense except above the 
patella. If fluid collects in the knee-joint, the bulging is naturally most 
pronounced in the upper part. The capsule is fortified by strong liga¬ 
ments, as well as by the so-called crucial ligaments which are placed in the 
interior of the joint so that femur and tibia remain closely together, espe¬ 
cially when the knee is bent, dhe head of the fibula is kept in close con 
tact with the lateral tuberosity of the tibia by means of a small, slightly 
movable joint, the superior tibio-flbular joint. The low ci ends of tibia 
and fibula, together with the astragalus, form the ankle-joint , the condyles of 
the two former grasping the latter like a fork. The joints placed between 
the astragalus and the calcaneum, and between these and the ante¬ 
rior bones of the metatarsus, enable elevation and depression of the two 
borders of the foot; that is, in and outward motion of the tip of the foot. 
The other joints of the foot have the same functions as the correspond¬ 


ing joints of the hand, 
















42 


THE STANDARD FAMILY PHYSICIAN 


.. Phalanges 


: Metacarpal 

1— bones 


VIII.—THE MUSCLES 

The skeleton of the human body is surrounded by muscles, which enable 
voluntary motion. Each muscle consists of a larger or smaller number of 
parallel fibers, known as the muscle-fibers. These fibers form muscle-bun¬ 
dles , separated by many strands of connective-tissue fibers. The striation 

seen with the unaided eye, if a 
muscle is cut longitudinally, is 
due to these muscle-bundles, but 
on cross-section they give the 
muscle a more mosaic-like ap¬ 
pearance. In order to see the 
separate muscle-fibers the aid of a 
microscope is necessary. At both 
ends muscles terminate in tendon- 
fibers, which are usually attached 
to some bone (see Fig. 16). 

The form of muscles varies 
considerably in different parts of 
the body. In the extremities they 
are generally spindle-shaped; that 
is, the ends of the muscles are 
pointed and pass over into elon¬ 
gated tendons. The muscles of 
the trunk are generally more flat 
and cover considerable surface; 
and their tendons (the abdomi¬ 
nal muscles are examples) have 
a more membranous structure. 
Besides these there are many other forms. Some muscles are fan-shaped 
(see “ pectoralis major ”; Plate I.), all the fibers converging toward one 
side; others possess two or more parts which finally end in a common tendon. 

Every striped muscle possesses the property, of contracting under the 
influence of the will; and as a result of such contraction it becomes shorter 
and thicker, while the bones to which it is attached approach each other 
(see Figs. 17 and 18). This mechanism explains all the motions of which 
the human body is capable. Even a layman can observe the contraction 
of a muscle since it becomes distinctly hard to the touch. If, for example, 
the right hand is placed upon the upper part of the left arm and the latter 
then brought into extreme flexion, the muscles of the anterior surface will 
be felt to assume the form of a hard ball. The contraction of the gastroc¬ 
nemius can be observed by lowering the tip of the foot. 



Wrist 


Ligament 


Wrist-joint 


Radius 


Ulna 


Fig. 43. Ligaments of the wrist and hand. 




















THE MUSCLES 


43 


The functional capacity of a muscle depends chiefly upon its thickness; 
and a voluminous muscle is therefore stronger than a thin one. The struc¬ 
ture of a muscle, however, also plays an important part. If a muscle re¬ 
mains inactive for a long period of time, the muscle-fibers frequently undergo 
fatty degeneration and may eventually disintegrate entirely; on the other 
hand, a muscle which is frequently called upon to contract may be able 
to do more than the usual amount of work. Fat-cells may accumulate 
also between the muscle-fibers, leading to a condition known as muscular 
atrophy. The muscles of a fractured arm, which is held tight in a plaster 
of Paris dressing, remain inac- 

become atrophied; and when the 
dressing is eventually removed 
the circumference of the arm 
may be reduced by as much as 
one-half. From this it follows 
that active daily exercise is nec¬ 
essary for the preservation of 
strong muscles. It must be 
borne in mind, however, that 
a fatigued muscle should always 
be allowed sufficient time to re¬ 
cuperate, before systematic ex¬ 
ercise is resorted to. If this is 
not done the size and functional 
power of the muscle may be 
lessened instead of increased. 

This is called overtraining a 
muscle. Most athletes are agreed 
that the best development is ob¬ 
tained by the frequent repetition of gentle exercise. For this reason dumb¬ 
bells weighing only a few pounds are generally used in the beginning, heavier 
weights being gradually selected. Excessive muscular exertion may react 
upon the entire system and give rise to muscular pains, sleeplessness, nervous 
disturbances of all kinds, temporary weakness of the heart, and albumin 
in the urine. All these symptoms are frequently observed in mountain 
climbers; and they may be caused also by excessive bicycle riding. The 
food also has a marked influence upon the development of the muscles. 
Alcoholic beverages are particularly injurious, because a prolonged period of 
fatigue follows the temporary stimulation. Contraction of striated muscles 
may be brought about also by mechanical stimulation. 

The following is a brief description of the most important muscles and 
muscle groups of the human body (see Plates I. and II.): 


tive for so long a time that they 



Fig. 44. The joints and ligaments of the pelvis. 


















































44 


THE STANDARD FAMILY PHYSICIAN 


Capsular 

Ligament 


1. The muscles of the head include the facial muscles which bring 
about the various expressions accompanying emotions, such as smiling, cry¬ 
ing, etc. The most important muscles of mastication are the temporal 
muscle (Plate II. i) and the masseter muscle (Plate VII. i) whose contrac¬ 
tions close the jaw firmly. A number of muscles in the orbits turn the 
eye-balls in various directions. 

2. The muscles of the back comprise a number of very strong muscles 
of which the more superficial ones ( trapezius and latissimus dorsi ) move 
the shoulder-girdle and the arm. The contraction of the trapezius (Plates 

I. 2 and II. 4) results in the backward movement 
of the shoulder; its uppermost fibers, which orig¬ 
inate at the back of the head, serve to raise the 
shoulders, and also functionate when weights are 
carried upon the shoulders or in the hands. 
This part of the muscle is strongly developed 
in hod-carriers. The latissimus dorsi (Plate II. 
5) directs the downward movement of the up¬ 
per arm, as when a descending blow is struck. 
The erector spince are placed deeply on both sides 
of the vertebral column, and serve to keep the 
spine erect. If the muscle of only one side 
contracts, the spine will be bent toward that side. 
The superior development of the erector spinae 
of one side may give rise to spinal curvature. 

3. The most superficial muscle of the neck 
Fig. 45. The knee-joint seen from is the platysma myoides (Plate I. 14) which is 

located directly under the skin, covering all the 
other muscles. It gives mobility to the skin of the neck, but it requires a 

certain amount of practise to operate this muscle. If the platysma be 

removed, the strongest muscles of the neck, the sternoclidomastoids (Plates 
I. 1 and II. 3), will come to view. The left muscle rotates the head toward 
the right and bends it toward the left side; the muscle of the right side 
directs the opposite movements. Both muscles together keep the head in 
place, but have nothing to do with the movements of nodding. A num¬ 
ber of smaller muscles placed between both sternoclidomastoids and the 
lower jaw serve to open the latter, and to move the larynx up and down 
during singing and talking. 

4. Among the muscles of the chest the most important is the pectoralis 
major (Plate I. 3) which moves the arms forward and inward, as in the 
act of hugging, or folding the arms. The intercostal muscles are seated 

more deeply between the ribs and assist respiration. The diaphragm 

(Plate V. 8 and 26) is a membranous muscle, shaped somewhat like a bell 
jar; it separates the chest from the belly cavities, During contraction it 



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PLATE II. —MUSCLES OF THE HUMAN BODY 

(From the back) 


1 . 

Temporal muscle 

13. 

Tendo Achillis 

2. 

Masseter 

14. 

Peroneus longus 

3. 

Sternoclidomastoid 

15. 

Peroneus brevis 

4. 

Trapezius 

16. 

Deltoid 

5. 

Latissimus aorsi 

17. 

Triceps 

6. 

External oblique of abdomen 

18. 

Extensors of arm 

7. 

Gluteus medius 

19. 

Flexors of arm 

8. 

Gluteus maximus 

20. 

Interrosseous muscles 

9. 

Semitendinosus 

21. 

Posterior muscles of 

10. 

Biceps of the thigh 

22. 

Flexors of thigh 

11. 

Semimembranosus 

23. 

Flexors of leg 

12. 

Gastrocnemius 

24. 

Peronei 


thigh 


( For a description of the functions of the various muscles, 


see pp. 42-47. 


See 


also index to the manikin) 


Plate II. 

























































THE MUSCLES 


45 


flattens, so that air is sucked into the lungs and an inspiration takes place. 
Simple expiration is brought about by relaxation of the muscle. The 
elasticity of the ribs and the upward movement of the diaphragm force 
the aii out of the lungs. In forced breathing, other muscles render assist¬ 
ance by raising and lowering the ribs. 


f' Phalanges 


y- Metatarsus 


Tarsus 


5. The muscles of the abdomen include only one which is visible upon 
the surface; namely the obliquus externus (Plates I. 8 and II. 6). This 
muscle, however, covers a number 
of other flat muscles in the front 
and lateral portions of the abdo¬ 
men. The common action of all 
these muscles is to exert pressure 
upon the abdominal entrails, in 
order to discharge feces and urine. 

With forced contraction, the ab¬ 
dominal muscles may also bend the 
trunk forward. 

Directly above Poupart’s liga¬ 
ment the abdominal muscles are 
perforated by an oblique canal, the 
inguinal canal , which is filled by 
the spermatic cord and vessels in 
man, and by the so-called round 
ligament and vessels in woman. 

Under abnormal conditions some 
loops of the intestines may force 
their way through this canal, result¬ 
ing in an inguinal hernia , or rup¬ 
ture. If the intestines pass through 
beneath Poupart’s ligament, the 
condition is spoken of as a jemoral 
hernia. In both cases the intestines are, however, covered by skin. See 
Rupture. 

6. The muscles of the upper extremities are divided into muscles of 
(a) the shoulder, (b) the upper arm, (c) the forearm, and (d) the hand. 
The most important of the shoulder muscles is the deltoid (Plates I. 15 
and II. 16), by the contraction of which the arm is raised. The muscles 
of the upper arm may be subdivided into flexors (Plate I. 16) situated on 
the front surface, and extensors (Plate II. 18), on the back surface of the 
arm. The most important flexor is the biceps (Plate I. 4); it can be readily 
felt as a globular swelling when the forearm is strongly bent, its chief func¬ 
tion being to cause flexion at the elbow. Upon the posterior surface of 
the arm there is only one single muscle, the triceps , contraction of which 


Ankle-joint 



Tibia—•" 


Fibula 


Fig. 46. The ligaments of the ankle and foot. 










46 


THE STANDARD FAMILY PHYSICIAN 


brings about straightening of the arm at the elbow (Plate II. 17). The 
muscles of the forearm also consist of flexors and extensors. The former 
(Plate I. 17) occupy the front and ulnar surfaces, and include muscles which 
bend the wrist and fingers forward, and rotate the forearm inward. They 
are concerned also in the grasping motions of the fingers. The extensors 
(Plates I. and II. 18) cover the back and radial surfaces, and enable straight¬ 
ening of the wrist and fingers, and outward rotation of the forearm. 

The muscles of the hand are divided into three groups: (a) Muscles 
of the thumb (Plate I. 6); (b) muscles of the little finger (Plate I. 7); and 
(c) muscles of the middle portion of the hand. Chief among those of the 
last-named group are the interosseous muscles (Plate II. 20) which sep¬ 
arate the fingers or bring them together sideways. 

7. The muscles of the lower extremities include the following groups: 

(a) Muscles of the hip; (b) muscles of the thigh; (c) muscles of the leg; 
and (d) muscles of the foot. The muscles of the hip are again divided 
into an anterior and a posterior group. To the former belong the psoas 
magnus and the iliacus, which help to form the posterior wall of the ab¬ 
domen (see Plate I. 19) and descend beneath Poupart’s ligament to the 
trochanter minor. A very well-developed muscle of the posterior group 
is the gluteus maximus (Plate II. 8), contraction of which draws the thigh 
backward; together with other muscles it also raises the body from a bend¬ 
ing position. Beneath this muscle are found the gluteus medius (Plate II. 
7) and the gluteus minimus which draw the thigh outward, and a number 
of smaller muscles, the so-called external rotators of the thigh. 

The thigh muscles form three large groups: (a) The extensors, (b) 
the flexors, and (c) the adductors. The extensors (Plate I. 21) occupy 
the anterior surface of the thigh; the most important of these are the sar- 
torius (Plate I. 9), which enables one to cross the legs, and the quadriceps 
extensor (Plate I. 10), which extends the leg. The flexors (Plate II. 22), 
situated upon the back of the thigh, are called the semitendinosus , the 
biceps , and the semimembranosus (Plate II. 9, 10, n). They serve to 
bend the leg; that is, draw it backward. The adductors , which are found 
upon the inner surface of the thigh, bring the legs together. The last- 
named group of muscles is generally well developed in riders. 

The muscles of the leg also form three groups, viz: (a) The extensors, 

(b) the flexors, and (c) the two peronei. The extensors (Plate I. 22) occupy 
the front surface; among them the long extensor of the great toe (Plate I. 
13) and the long extensor of the remaining toes (Plate I. 12) serve to extend 
the toes, while the tibialis anticus (Plate I. 11) raises the inner margin of 
the foot. The flexors (Plate II. 23) form the calf of the leg. The most 
prominent muscle of this group is the gastrocnemius (Plate II. 12) which 
lowers the tip of the foot, thereby raising the body on the toes. It ter¬ 
minates as a very well-developed tendon, known as the tendo Achillis 




INTERNAL ORGANS 


47 


(Plate II. 13). Mountain guides and dancers, who use the tip of the foot 
rather than the entire sole, usually have a prominent calf, since the size 
of this part of the leg depends chiefly upon the gastrocnemius. The two 
long flexors of the toes are placed beneath the gastrocnemius, as is also 
the tibialis posticus , which turns the sole of the foot inward. The pero- 
neus longus and the peroneus brevis (Plate II. 14, 15, 24) serve to elevate the 
outer border of the foot. They are important muscles in holding the 
ankle steady, as in skating. 

The muscles of the foot, in analogy with those of the hand, are classified 
into muscles of the great toe, muscles of the little toe, and muscles of the 
median portion of the foot. Their functions are in the main the same as 
those of the corresponding muscles of the hand. On the upper surface 
of the foot there are, however, two additional short extensor muscles, one 
for the great toe and another for the remaining four (Plate I. 23); and 
on the lower surface, a short flexor for the four smaller toes. 


IX.—INTERNAL ORGANS 

The internal viscera comprise a number of organs which are placed 
chiefly in the interior of the body. Their functions are very varied: the 
organs of breathing and digestion take in certain substances which are 
necessary for the body; the urinary organs hold certain excretory products; 
and the sexual organs preside over the function of reproduction. The 
brain, spinal cord, and heart are by some not included among the viscera, 
since the two former really belong to the nervous system and the latter to 
the circulatory system. 

Every system of viscera possesses cavities which communicate with the 
external air and which permit of a discharge of their contents. Each cav¬ 
ity is lined by a smooth, red and slippery membrane, which is known as 
mucous membrane because it secretes mucus under normal as well as under 
diseased conditions. For this purpose, many mucous glands are embedded 
in the mucous membrane. These glands are generally so small that they 
can be detected only under the microscope; but occasionally they may 
attain the size of a pea. The red lining seen on looking into the mouth 
is mucous membrane. 

1. The Organs of Respiration include (a) the nasal fossae, (b) the phar¬ 
ynx, (c) the larynx, (d) the trachea, and (e) the two lungs. 

The nasal fossae (Fig. 47) begin at the two nostrils, and end at the con¬ 
siderably larger posterior nares which pass over into the uppermost part 
of the pharynx. The left nasal cavity is separated from the right bv the 
septum , which is generally bent slightly to one side. The palate forms 
the floor of the nasal cavity, and at the same time separates the latter from 





48 


THE STANDARD FAMILY PHYSICIAN 


the mouth. Upon the lateral (outer) walls of the nasal cavities are found 
three elongated prominences, known as the tuvbinoted bones, which are 
directed obliquely downward. The upper is the smallest, the lower the 
largest of the three. These prominences are supplied upon their surface 
with many blood-vessels which rapidly heat the air as it passes through 
the nose. The mucus present in the interior of the nose serves to entangle 



Fig. 47. Cross-section through the middle of the head and neck. 

1, Frontal sinus; 2, 3, 4, upper, middle, and lower turbinated bones; 5, hard palate; 6, tongue; 7, hyoid 
bone; 8, epiglottis; 9, larynx; 10, trachea; ii, thyroid; 12, cerebellum; 13, medulla; 14, naso¬ 
pharynx; 15, Eustachian tube; 16, soft palate; 17, pharynx; 18, esophagus; 19, spinal cord. 


small particles of dust which are inhaled with the air, thus preventing them 
from reaching the deeper parts of the respiratory tract. This mucus is 
slowly carried forward by means of ciliated epithelial cells found in the 
back of the nose, so that admirable conditions are present for purifying 
the air which passes through. It is therefore always advisable to breathe 
through the nose and not through the mouth, because in the latter case 
cold air and various impurities may easily get into the lungs. The organ 
of smell is located in the upper half of the nasal cavity, where the terminal 








































INTERNAL ORGANS 


49 


branches of the olfactory nerve spread out in the mucous membrane and 
thus come into contact with the air. 

The pharynx is the cavity situated behind the posterior nares, the mouth 
and the iarynx; and it may thus be divided into three parts: (i) the naso¬ 
pharynx, placed behind the nasal cavity; (2) the oro-pharynx, behind the 
mouth; and (3) the laryngo-pharynx, behind the larynx. Only the upper 
and middle portions transmit air, the lower portions forming a passageway 
for food as it is transmitted into the esophagus. In the naso-pharynx is 



Thyroid 

cartilage 


Cricoid 

cartilage 


Epiglottis 


"Tracheal 
- rings 



Epiglottis 


Thyroid 

cartilage 


Cricoid 

cartilage 


Rings of 
trachea 


Fig. 48. The larynx seen from in front. 


Fig. 49. The larynx seen from the side. 


(The various cartilages are held together by ligamentous bands.) 


located the opening of the Eustachian tube, a funnel-shaped canal which 
serves to connect the naso-pharynx with the middle ear or tympanic cav¬ 
ity. Through this canal inflammatory processes may easily spread from 
the nasal cavity or naso-pharynx to the middle ear and drum-membrane, 
and thus give rise to inflammation of the middle ear (see Ear, Diseases of). 

The larynx is an organ consisting of cartilages, ligaments, and mus¬ 
cles. The largest cartilage ( thyroid cartilage) can be easily felt by passing 
the finger along the middle line of the neck in front. In men this cartilage 
is especially prominent,and forms the so-called Adam's apple. Below the 
thyroid cartilage are the cricoid cartilages, and on the upper, posterior por¬ 
tion of the latter, the arytenoid cartilages (Figs. 48, 49, 50). The cartilages 
are connected by joints and ligaments, and may be moved upon each other 
by means of muscles. The most important ligaments are the vocal cords, 
a false and a true one being placed one above the other on each side. The 
space between the true vocal cords is known as the glottis. 








50 


THE STiVNDARD FAMILY PHYSICIAN 




Vocal 

cord 


Vocal 

cord 

muscles 


^Thyroid 

cartilage 


Cricoid 

cartilage 


Fig. 50. Structure of interior of larynx from side. 


A general idea of the shape of the vocal cords can be obtained from 
Fig. 51. In this illustration the larynx appears as if cut through on a plane 
parallel with the forehead, so that the front ends of the vocal cords are 

exposed to view. It is appar¬ 
ent that the interior of the 
larynx is considerably narrowed 
by the vocal cords projecting 
from the right and left sides. 
When the true cords approach 
each other so closely that their 
edges come into contact, the 
larynx will be closed and ex¬ 
piration rendered impossible. 
The voice is produced by the 
impact of air on the periodi¬ 
cally opened and closed true 
vocal cords. A certain amount 
of tension on the part of the 
vocal cords is necessary in order to produce sound, and this is brought 
about by the laryngeal muscles, which also dilate and contract the glottis. 
The larynx, however, has nothing to do with the production of speech, 
whispering being still possible if 
it is removed (see Part II., s. v. 

Voice and Speech). 

The trachea is the direct con¬ 
tinuation of the larynx. It is 
placed in the middle line of the 
neck, directly under the skin, and 
in front of the esophagus. En¬ 
tering the chest it finally divides 
at the level of the fourth dorsal 
vertebra into the two bronchi , of 
which the left enters the left lung 
and the right the right lung 
(Plate IV. 20, 23 and 6). The 
left bronchus again divides into 
two and the right into three 
branches, corresponding to the 
lobes of the lungs. Each branch 
breaks up into smaller ones like 
the branches of a tree, so that the diameter of the terminal bronchi does 
not exceed -fa of an inch (see Fig. 52). Horseshoe-shaped pieces of 


Left 
vocal - 
cord 


Epiglottis 


Thyroid cartilage 
False vocal cords 
Pocket 

rue vocal cords 
“Vocal cord muscles 


"Cricoid cartilage 


-Tracheal ring 

Trachea 


Fig. si- 


Structure of interior of larynx, seen from 
in front. 


cartilage (see Fig. 49) are placed in the walls of the trachea to keep it 














INTERNAL ORGANS 


51 


open, and the bronchi are supplied with similar irregular plates. The inner 
surfaces of the trachea and the bronchi are lined, like the larynx, with mu¬ 
cous membrane with ciliated epithelium. 

The thyroid gland, a peculiar, horseshoe-shaped organ (Plate IV. 19), 
is placed in front of the uppermost portion of the trachea. Properly speak- 
ing, however, it can not be classed among glands, since it does not possess 
an excretory duct after birth. The narrow middle portion is located di¬ 
rectly in front of the trachea, 
whereas the two thickened lat¬ 
eral portions lie by the sides of 
the larynx, their pointed ends 
projecting upward. 

The functions of the thyroid 
gland are not well known. It is, 
however, supposed that certain 
substances necessary for the body 
are absorbed by the blood as it 
flows through this organ. At all 
events it is certain that diseased 
conditions of the organ interfere 
seriously with health. A disease 
known as Goiter, which consists 
in a morbid enlargement of the 
thyroid gland, is common in cer¬ 
tain mountainous regions and 
may cause very disagreeable 
symptoms. Enlargement of this organ also occurs in Exophthalmic 
Goiter, a disease which is characterized by marked protrusion of the 
eyeballs. For the morbid conditions resulting from atrophy of the thyroid 
gland see Thyroid Gland, Diseases of. 

The lungs are two spongy, air-filled organs which occupy the greater 
part of the thorax (Plate III. 3 and 12). Almost the entire process of 
respiration goes on within them. Their flattened and somewhat hollowed 
base rests upon the diaphragm; the apex projects from 1 to ij inches 
above the clavicle and first rib; the inner, or mesial, surface adjoins the 
heart; and the lateral, or outer, surface the thoracic wall. The bronchi, 
and the pulmonary arteries and veins form a thick strand, known as the 
root of the lung, which enters the lung upon its mesial surface. The color 
of the lungs is yellowish white in animals and newly-born infants, while 
in adults it is slate-tinted or, in places, even black, owing to the deposit of 
small particles of coal which are constantly present in the air of smoky 
or dusty towns. The shade of red (pink to dark red) depends upon the 
amount of blood present. 



Fig. 52. 


The larynx, trachea, and bronchi, and their 
branches. Seen from the front. 














52 


THE STANDARD FAMILY PHYSICIAN 


The finer structure of the lungs is as 

follows: Every terminal bronchus ends 
in a small air-sac which has numerous 
excavations upon its surface and is ad¬ 
herent to the neighboring sac. The 
walls of the sac are abundantly supplied 
with elastic fibers which give the lung its 
pronounced elasticity. When taken out 
of the body a lung will contract and 
force out all its air, but it may again be 

Fl of 5 the ^ibs a during distended by blowing air through the 
breathing. bronchus. The lungs would contract 

also within the body, were it not for the fact that they are 
closely applied to the unyielding walls of the chest. 

The walls of the air-sacs also contain a very fine net¬ 
work of blood-vessels, whose exceedingly thin walls lie so 
near the surface that they almost come into contact with 

. Fig. 54- Movement of 

the air of respiration. In these vessels an exchange of the diaphragm and 

1 abdominal wall dur- 

gases takes place between the air and the blood. The in ® breathing. 

red blood-corpuscles attract the oxygen of 
the inhaled air, while the blood gives off 
carbonic acid and water vapor to the expired 
air. In cold weather the presence of these 
vapors renders the expired air visible. The 
elevation of the chest with inspiration, and 
the depression with expiration, can be readily 
felt by placing the hands flat upon the chest 
while breathing deeply. If the vertebral 
column be looked upon as a perpendicular 
line, and the ribs as a ring articulating with 
this line (see Fig. 53), the position of rest is 
shown at 1. If the ring be raised to position 
2, an inspiration will follow; if again lowered 
to 1, an expiration will result. From this it 
follows that a contraction of the muscles 
connected with the chest is required only 
during inhalation. With forced expiration, 
however, the ring is lowered still further to 
the position indicated by 3. This form of 
respiration is known as thoracic or costal 
breathing. 

In addition to the ribs, the diaphragm and abdominal muscles are also 
active during breathing; and it can be readily observed that the former 



Fig. 55. The female type of breathing. 




























INTERNAL ORGANS 


53 


muscle imparts its movements to the abdominal walls (see Fig. 54). The 
position indicated at 1 shows the diaphragm at rest; as it contracts it be¬ 
comes flattened (assuming position 2), thereby sucking air into the chest 
(inspiration). At the same time it presses somewhat upon the abdominal 
organs, so that the abdominal walls move forward (from position a to b). 
This in turn causes the abdominal muscles to contract, thus exerting a pres¬ 
sure upon the abdominal organs which again force the diaphragm upward. 
This type of breathing is called diaphragmatic or abdominal , and is the usual 
form of respiration in the male sex because the excursions of the abdominal 
wall are greater than those of the thorax. In the female sex, however, the 
thoracic type is prevailing since the ribs participate more in breathing; 
hence the phrase “heaving of the bosom” (see Fig. 55, where the shaded 
portion indicates the change in shape with inhalation). 

The outer surface of the lung is covered by a smooth, glistening mem¬ 
brane, the pleura , which adheres so firmly to the lung that it can not be 
stripped off. This part of the pleura is called the inner layer. The pleura 
covers also the root of the lung and is then reflected upon the inner sur¬ 
face of the thoracic wall, where (under the name of costal or outer layer) 
it clothes the upper surface of the diaphragm and the lateral surface of 
the heart (Plate III. 4 and 13), being firmly adherent also to these parts. 
A small amount of lymphatic fluid, contained between the inner and outer 
layers of the pleura, acts as a lubricant. In pleurisy, “water in the chest,” 
etc., the amount of fluid between the two layers may be greatly increased. 
The lung will then be pushed away from the wall of the chest, and is often 
so much compressed that breathing becomes very difficult (see Pleurisy). 

2. The Organs of Digestion comprise the following: (a) The mouth 
and the salivary glands; (b) the pharynx; (c) the esophagus; (d) the 
stomach; and (e) the intestines, with liver and pancreas. The spleen is 
frequently classed with the digestive organs although it has nothing to do 
with digestion. It is known to elaborate certain constituents of the blood. 

The mouth may be divided into three parts: the vestibule of the mouth; 
the mouth proper; and the back of the mouth. 

The vestibule constitutes the narrow space between lips and cheeks on 
one side and the front surface of the teeth on the other. The entrance is 
formed by the lips, and is known as the oral orifice. Part of each tooth 
is contained in the bony substance of the upper or lower jaw; a part is 
covered by the gums; and a third part projects free into the mouth. The 
first portion is the root; the second, slightly constricted, portion, the neck; 
and the third, exposed, portion, the crown of the tooth. The crown is 
covered on its upper surface by an exceedingly hard substance, the enamel. 
The interior of each tooth contains the dental cavity, filled with a pale 
red, soft substance (the pulp ) which is composed of the nerves and blood¬ 
vessels of the tooth. The periosteum of the tooth forms a thin membrane 






54 


THE STANDARD FAMILY PHYSICIAN 


on the surface of the root; in bad teeth it frequently becomes inflamed 
and gives rise to severe pain. 

The normal number of teeth for adults is thirty-two; that is, eight for 
each half of each jaw. Beginning from in front there are on each side 
two incisors , one canine , two bicuspids and three molars. During child¬ 
hood the incisors have three distinct prongs, but as these are used up they 
become chisel-shaped. They are used for seizing and biting off morsels 
of food. The canines are prominent, awl-shaped teeth. In beasts of prey 
they form hooks so that the prey can be more readily held. The bicuspids 
have two prongs upon their chewing surface; the molars four to five. The 
chief function of these teeth is to crush and grind the food. 

With rare exceptions every human being is born without teeth. Be¬ 
tween the sixth or seventh month and the beginning of the third year, the 
temporary teeth, or milk teeth, make their appearance. They are called 
temporary because they fall out later, and are replaced by the permanent 
set. The temporary set consists of incisors, canines, and two premolars 
with four or five projections upon the free surface. Each half of the upper 
and lower jaw has, therefore, five teeth instead of eight. The temporary 
teeth are replaced by the permanent between the sixth and twelfth years. 
The three most posterior molars of each side, however, appear only once; 
the first between the fifth and sixth, the second between the twelfth and 
fourteenth, and the third between the twentieth and fortieth years. It fol¬ 
lows that the first molars are the oldest of the teeth of adults, and hence 
wear off before the others. The third molars are frequently called “wis¬ 
dom teeth”; their eruption is often very painful because the gums have 
usually attained considerable firmness at the time of their appearance. 

The mouth proper contains upon its floor the tongue, which is chiefly 
made up of striated muscle-fibers. These are covered by a mucous mem¬ 
brane, containing many small projections ( papillce ) in which the nerves of 
taste terminate. The lower surface of the tongue is connected with the 
floor of the mouth in the median line by a fold of mucous membrane, known 
as the Jrenum. The tongue is the chief organ of speech; yet it is a mis¬ 
take to believe that children will acquire speech more readily if the frenum 
be cut or loosened (see Tongue-Tie). The roof of the mouth is formed 
by the palate, the anterior, bony portion of which is called the hard palate 
and the posterior, movable portion, the sojt palate. If the soft palate is 
raised, as in swallowing, the uppermost portion of the pharynx and the 
nasal cavity may be completely closed. The posterior edge of the soft 
palate shows an elongation, the uvula, which is of no special importance. 

The excretory ducts of three salivary glands empty into the mouth proper 
on each side. These glands produce the saliva, the functions of which are 
to lubricate the mouth, to bring into solution the starchy ingredients of 
food by converting them into sugar, and to thoroughly moisten the food. 







INTERNAL ORGANS 


55 


Hard 

Palate 


The largest salivary gland is the parotid (Plate X. i), a flat, triangular 
organ which is placed directly in front of the ear and beneath the zygo¬ 
matic arch. Its excretory duct, which has the size of a goose-quill, empties 
into the mouth opposite the last molar tooth. Inflammation of this gland 
by a special infection leads to Mumps (which see). The submaxillary 
gland (Plate X. 2) is about half as large as a walnut and is placed mesial 
to the angle of the lower jaw. The sublingual glands lie upon the floor 
of the mouth on both 

sides of the frenum of 
the tongue, where the 
excretory ducts of the 
submaxillary glands may 
also be found. 

The back of the mouth 
is a triangular space, 
the apex of which corre¬ 
sponds to the posterior 
edge of the soft palate 
(see Fig. 56). The base 
lies next to the base of 
the tongue, and the an¬ 
terior and posterior lim¬ 
its are formed by two 
folds of mucous mem- Pkaijhx 
brane, known respective¬ 
ly as the anterior and 
posterior palatine arch. 

Between these two arches 
may be seen an almond-shaped elevation, the tonsil. The tonsils may be 
regarded as lymph-nodes into which the lymph-channels of the pharynx 
and mouth drain. They may enlarge to the size of walnuts, and may even 
touch one another, thereby closing the entrance into the pharynx. In such 
cases it becomes necessary to remove the enlarged organs by an operation. 

The pharynx has already been described as an organ of respiration in 
the preceding chapter. Only the middle portion, behind the mouth, and 
the lower portion, behind the larynx, act as a passageway for food. The 
food is propelled downward by means of flat, striated muscle-fibers which 
lie in the walls of the pharynx, and which are known collectively as the 
constrictors of the pharynx. The inner surface of the pharynx is abun¬ 
dantly supplied with mucous glands which produce the large amount of 
mucus generally troubling smokers and drinkers in the morning, and which 
makes it necessary for such people to frequently clear the throat by hawk¬ 
ing and coughing. 



Anterior 
Palatine Arch 

" Tonsil 

Posterior 
Palatine Arch 


Pig. 56. View of mouth and pharynx, the jaws being wide open. 








































56 


THE STANDARD FAMILY PHYSICIAN 


The esophagus, or gullet , is a continuation of the pharynx (see Plate I\ . 
7) and consists of a cylindrical tube which enters the thorax behind the 
trachea and in front of the vertebral column, finally penetrating the dia¬ 
phragm to become continuous with the stomach. The wall of the esoph¬ 
agus contains many muscle-fibers, but these are smooth and not under the 
influence of the will. For this reason the food, after being swallowed, is 
involuntarily forced down into the stomach. 

The stomach (Plates IV. 27, and III. 15) is an approximately pear-shaped 
organ. On the left side, directly under the diaphragm, it communicates 
with the esophagus by means of the cardiac orifice; and on the right side 
it is continued into the intestines by means of a ring-shaped constriction, 
the pylorus. The large dilated portion directed upward and to the left, 
toward the diaphragm, is known as the fundus. The largest part of the 
stomach is placed in the left side of the body, and only one-sixth extends 
beyond the middle line to the right. Another small portion is in contact 
with the anterior abdominal wall, directly under the liver in the epigastric 
fossa. The size of the stomach depends largely upon the amount of 
fluid it contains, and also upon the degree of contraction or relaxation of 
the smooth muscle-fibers present in its walls. Besides this, the size varies 
considerably in different people. Even a healthy stomach may extend as 
far as the navel if distended. If it reaches still lower down, it is spoken 
of as a morbid dilatation of the stomach (see Stomach, Dilatation of). 

The stomach serves to store up the undigested food temporarily, to 
thoroughly mix the food, to begin the digestion of albuminous foods (meats, 
etc.), and to loosen up the fats from their connective tissue envelopments. 
These functions are possible by reason of the gastric juice, which is secreted 
by many glands placed in the mucous membrane of the organ. 

The gastric juice is a pale fluid containing \ per cent, hydrochloric 
acid mixed with a peculiar chemical substance (a ferment) called pepsin. 
The digestion of food depends chiefly upon the presence of a sufficient amount 
of this gastric juice. The digestibility of various articles of food varies, 
however, within wide limits (see Foodstuffs). Thus fat meat is more 
difficult to digest than lean, because it takes longer for the watery gastric 
juice to penetrate the former than the latter. It is of the utmost impor¬ 
tance thoroughly to chew all food taken in, as this will insure thorough 
moistening with saliva and permit the gastric juice to penetrate better. 
Palatable foods cause all digestive fluids to be secreted more abundantly, 
and the entire process of digestion to be more rapidly completed. For this 
reason children should never be forced to eat food for which they have a 
distaste. During sleep and after severe bodily exertion digestion proceeds 
very slowly, and the stomach should, therefore, not be overfilled at such times. 

The intestinal tract is a tube six to seven yards long, which is attached 
to the pylorus. Its chief functions are to complete digestion and to absorb 






INTERNAL ORGANS 


57 


food which has been dissolved and chemically altered by the digestive 
fluids, and which is then carried into the circulation of the body by way 
of the lymphatics. The length of the intestines varies in man and in the 
different animals. Grass-eating animals, who digest slowly, usually have 
a very long gut and take in large amounts of food; while meat-eating 
animals are generally satisfied with one meal a day, their intestines being 
considerably shorter. The actual length of the intestinal tract in man 
is, however, considerable; and as it lies in the abdomen, the gut forms a 
number of curves known as the intestinal loops. 

The intestinal tract is divided into the small and the large intestine. 
The former digests and absorbs, while the latter stores up the undigested 
fecal matter preparatory to its discharge from the body. 

The small intestine (Plate III. 18) is divided into three parts: the duo¬ 
denum, the jejunum, and the ileum. Of these the duodenum (from Latin 
duodeni, “twelve each,” its length being about equal to twelve finger-breadths) 
is the shortest; it is approximately horseshoe-shaped, and its hollowed side 
to the left contains the head of the pancreas. The jejunum (from Latin 
jejunus , “hungry”) is generally empty after death. It passes insensibly into 
the ileum which forms many loops in the abdominal cavity, finally joining the 
large intestine in the right iliac region (Plate IV. 16). At the point of juncture 
there is a two-lipped valve (valve of Bauhini), which is so arranged that 
the contents of the large intestine can not pass back into the small. The 
current of feces, therefore, is always in the direction from the small to the 
large intestine. Both jejunum and ileum are fastened to the posterior abdom¬ 
inal wall by means of a membranous structure known as the mesentery. 

The large intestine is also divided into three portions: the caecum, the 
colon and the rectum. As a whole the large intestine forms an incomplete 
quadrangle (Plate III. 8, 16, 17) which surrounds the loops of the small 
intestine like a frame. The caecum (Plate IV. 15) forms the shortest part 
of the large intestine; it constitutes a short pouch-like structure in the 
lower right portion of the abdomen near the right iliac fossa, and the small 
intestine empties into it. It is characterized also by the presence of a 
worm-shaped appendage, known as the vermijorm appendix (Plate IV. 17). 
This appendix is not only unnecessary for man, but often actually danger¬ 
ous since it may form the starting point for a fatal peritonitis (see Appen¬ 
dicitis; Peritonitis). The caecum passes insensibly into the colon, the 
largest portion of the large intestine. The colon first ascends on the right 
side (ascending colon; see Plates IV. 13 and III. 8); it then crosses at 
right angles to the left side (transverse colon; Plates III. 16 and IV. 11, 
29), along which it descends at another right angle (descending colon; 
Plates III. 17 and IV. 31), finally forming an S-shaped loop ( sigmoid flex¬ 
ure; Plate IV. 32) which joins the rectum. The rectum is the termination 
of the large intestine which lies in the true pelvis (Plate IV. 33). 






58 


THE STANDARD FAMILY PHYSICIAN 


The liver (Plates III. 6, 14; IV. 9) is the largest gland of the human 
body and chiefly occupies the space beneath the diaphragm. On the left 
side it touches the stomach. Its chief function is to elaborate the bile, 
which modifies the fats of the food so that they can be absorbed by the 
intestines. As the bile is secreted it collects within the liver in a number 
of fine ducts, the biliary ducts , which lead into a larger one, the hepatic 
duct , placed at the lower surface of the liver. This duct is connected with 
a pear-shaped organ, the gall-bladder (Plate III. 7), the excretory duct of 
which joins that of the liver to form the common bile-duct (Plate IV. 10) 
which finally empties the bile into the middle portion of the duodenum. 

The pancreas (Plate IV. 28) is a gland of considerable size, the most 
intimately known function of which is the production of pancreatic juice. 
It is of elongated, triangular form, and is placed along the posterior abdom¬ 
inal wall behind the transverse colon and the stomach. The left, narrow 
end touches the spleen; the right, thicker end fills out the concavity formed 
by the duodenum. The excretory duct of the pancreas lies in the long 
axis of the organ, and empties into the duodenum at the same place where 
the bile-duct penetrates the gut. The pancreatic juice has a complex ac¬ 
tion upon food since it contains at least three digestive ferments, which 
convert starches into sugar, digest the proteid foods (albumin, connective 
tissue, gelatin, etc.), and also render fats more digestible. 

The spleen (Plate IV. 26) may be described with the digestive organs 
although it is only placed in immediate proximity to these, without par¬ 
ticipating in the actual process of digestion. It has the size of a small 
fist and the shape of a coffee bean; and it is situated to the left of the spinal 
column, between the stomach and the diaphragm. In diseases (as in malaria 
or typhoid) the spleen may enlarge considerably, and may even be felt 
beneath the ribs in the left side. After excessive exercise the organ may 
become overfilled with blood and give rise to disagreeable stitches in the 
side. The functions of the spleen are not thoroughly understood. It elab¬ 
orates certain elements of the blood, besides having other less well-known 
functions. 

The inner surface of the abdominal walls is covered by the outer layer 
of the peritoneum. At the posterior abdominal wall, this layer is reflected 
as a more or less complete cover of most abdominal organs. The mesen¬ 
tery, already mentioned, is a continuation of the peritoneum, and connects 
the outer layer of the latter with the intestines. The great omentum (not 
shown on Plate III.), which hangs down from the transverse colon and 
covers the small intestine, is merely an apron-like prolongation of the mes¬ 
entery. The peritoneum is a thin, smooth membrane which imparts to 
the intestines their normal, glossy appearance. 

3. The Urinary Organs include: (a) the two kidneys, (b) the two ureters, 
(c) the bladder, and (d) the urethra. 







INTERNAL ORGANS 


59 


The kidneys (Plate V. n, 30) are bean-shaped organs lying along the 
posterior abdominal wall on both sides of the lumbar vertebrae. Each 
kidney is so placed that its indented mesial edge points toward the spine. 
This edge forms a fissure-like depression (the hilum) where the large blood¬ 
vessels enter and the ureter leaves the organ (Plate V. 10, 13, 29, 37). Both 
kidneys are held in place by a deposit of fat, which is known as the fatty 
capsule of the kidney. The finer structure of the kidney resembles that 
of a gland. It is made up of a number of much contorted and twisted tubes, 
the urinijerous tubules , which all empty into the ureter at the hilum. The 
chief function of the kidney is to make the urine. This fluid is derived in 
part by filtration from the blood which flows through the kidneys; but it 
also contains substances secreted by the epithelial cells which line the 
uriniferous tubules. The chief substances derived from the blood are water 
and various salts, while those secreted by the epithelial cells are urea, uric 
acid, and other principles which are removed from the blood. The color 
of urine depends chiefly upon the amount of water it contains; if a large 
quantity of water is present, it appears pale; while with less water and more 
salts, it becomes darker (see Urine). The color as well as the amount 
of the excreted urine stands in close relation to the amount of fluid ingested 
and to the quantity of water lost by perspiration. If one drinks much, 
the urine will be abundant and pale in color; if perspiration is active, the 
color will be darker and the amount less. 

The two ureters (Plate V. 13, 37) convey urine from the kidneys to the 
bladder. They originate at the hilum of the kidneys, in a dilatation known 
as the renal pelvis , and then pass downward along both sides of the spine, 
emptying into the deepest part (or floor) of the bladder. When distended, 
their thickness is about that of a pen-holder. 

The bladder (Plates III. 9; IV. 34; V. 18) is an egg-shaped organ. 
When completely filled with urine, it may reach as high as the navel; but 
when empty it occupies only the space behind the pubic symphysis. In 
keeping with the more roomy pelvis, the bladder is larger and broader in 
the female sex than in the male. The bladder may be regarded as a recep¬ 
tacle which stores up the urine secreted by the kidneys and carried down 
to it by the ureters. The urine is prevented from flowing out of the bladder 
by a ring of smooth muscle tissue ( sphincter ) which is usually tightly con¬ 
tracted. Many muscle-fibers are placed also within the walls of the blad¬ 
der, and by their contraction these aid in forcing out the urine. As soon 
as the bladder becomes distended by the presence of urine, the muscle- 
fibers in its walls contract and start the impulse to urinate; this impulse, 
reinforced by the will, causes the sphincter to relax, thereby permitting 
the urine to flow out of the bladder through the urethra. In the female 
the urethra is only about an inch long; in man, however, it attains a length 
of from eight to ten inches. 




60 


THE STANDARD FAMILY PHYSICIAN 


X.—THE CIRCULATORY SYSTEM 

The chief organs of the vascular system are the blood- and lymph- 
vessels, containing respectively blood and lymph. The lymph is a clear 
fluid which may be described as blood without the red blood-corpuscles. 
The nourishment of the body depends chiefly upon this lymph, since it 
saturates all tissues and surrounds all cells so that these can absorb the 
necessary nutritive material from it. The lymph of the tissues is first col¬ 
lected in exceedingly thin, delicate tubes, the fine lymph-channels, which 
gradually unite to form larger vessels. The two chief trunks empty into the 
circulatory system by way of the subclavian veins. Since the lymph-vessels 
absorb the lymph and carry it into the blood, they have also been called 
absorbent vessels. 

The blood-vessels, on the other hand, form a completely closed system 
of tubes, filled with blood. The fluid constituents of the blood pass through 
the walls of the blood-vessels, and thus form the lymph. Some of the white 
corpuscles also penetrate the walls; but under normal conditions the red 
cells escape only when there is a tear in the walls of the vessels. The ves¬ 
sels which carry the blood from the heart to the different organs are called 
arteries. By constantly subdividing, they become smaller and smaller, 
finally forming the capillaries which can be seen only with high magnifying 
powers, and which no longer form distinct branches, but a sort of network. 
This network again collects into separate vessels which gradually increase 
in size, finally forming large trunks which empty into the heart. The 
vessels which serve to carry the blood back again to the heart are called 
veins. 

i. The Heart is a hollow cone-like organ consisting of involuntary, 
striped muscle-tissue, the contractions of which serve to keep the blood in con¬ 
stant motion. It is an ingenious and marvelous pump. The apex of the 
heart (Plate V.) points to the left, forward and downward; its base, to the 
right, backward and upward. The position of the apex corresponds to 
an area in the space between the fifth and sixth ribs, just beneath the nipple. 
Here the apex impulse may be felt by the hand if the body is inclined slightly 
forward. When the contraction of the heart forces the blood into the arter¬ 
ies, the apex is thrown against the chest wall, just as a gun when fired recoils 
against the shoulder. j 

A dividing wall, composed of muscle and connective tissue, divides 
the heart into a left and a right half. A constriction, visible externally, divides 
each half into an upper cavity, the auricle , and a lower one, the ventricle, 
so that every heart is made up of four separate chambers, the two auricles 
and the two ventricles. The right auricle receives the blood from the 
upper half of the body through a large vein, the superior vena cava , and 
















THE CIRCULATORY SYSTEM 


61 


that of the lower half of the body through another large vein, the inferior 
vena cava; while the blood from both lungs empties into the left auricle 
through the two left and the two right pulmonary veins. The large arteries 
of the heart, which carry the blood from the heart to the different organs, 
arise from the ventricles. The artery of the right ventricle, known as the 
pulmonary artery , divides very soon into two branches which carry the 
blood to the left and right lung respectively. The artery of the left ven¬ 
tricle is the largest in the human body and is called the aorta; it conveys 
blood to all the organs of the body except the lungs. 

The current of blood is always in the same direction: from the veins 
into the auricles, from these into the ventricles, then into the arteries, and, 
finally, through the capillaries back again into the veins. The proper 
direction of the current is insured by the interposition of two sets of valves 
which close as soon as the blood tends to flow backward. One set of valves 
is placed between the auricles and ventricles; the one on the left side has 
two flaps and is called the mitral or bicuspid valve, whereas the valve on 
the right side has three flaps, wherefore it is known as the tricuspid valve 
(Plate VI. i, 3). When the ventricles contract, both valves close so that 
the blood can not go backward into the auricles, but must flow into, and 
distend, the arteries. The reflux of blood from the arteries into the ven¬ 
tricles is prevented by three semi-lunar valves placed at the beginning of 
the arteries (Plate VI. 1, 2). The contraction of the ventricles forces the 
blood intermittently into the arteries, thus giving rise to the pulse, which 
can be easily felt with the fingers where a large artery runs a superficial 
course. A physician generally determines the quality of the pulse at the 
radial artery (see p. 63), which is readily felt near the outer side of the 
wrist-joint. From the arteries the blood is propelled into the capillaries 
by the contraction of the elastic walls of the former. The movement of 
blood in the capillaries is very slow, and it becomes still slower in the veins 
where a certain amount of suction toward the heart takes place. 

With regard to its action, the heart may thus be compared to two pumps 
working side by side—the right and the left hearts. The venous blood 
flows into the right auricle which contracts and forces it into the right ven¬ 
tricle; this in turn forces the blood into the lungs to be oxygenated and 
to give off the impurities it has collected in its passage through the body. 
From the lungs the blood passes into the left auricle, and thence into the 
left ventricle, which again forces it into the aorta. The auricles and the 
ventricles contract rhythmically, first one, then the other. In some people 
and in some diseases the contractions of the auricles can be felt in the pulse 
as a faint wave (see Heart, Diseases of). 

The pericardium is a membranous bag which surrounds the heart, and 
which enables it to contract and relax without friction. Large amounts 
af fluid may accumulate in this sac in disease. 



62 


THE STANDARD FAMILY PHYSICIAN 


The heart-muscle has the structure and properties of a striated muscle. 
It is not surprising, therefore, that it may show fatigue, as after severe 
bodily exertion or continued excitement. Individuals with fatigued heart- 
muscle become pale because the heart no longer possesses the force to propel 
the blood through the vessels with normal rapidity. Sudden fatigue of the 
heart (as after prolonged swimming in cold water) may even cause fatal 
paralysis of the heart-muscle. Fatty degeneration of the heart, leading to 
disturbances in circulation and in general health, may follow after disease, 
over-exertion, or continued indulgence in alcoholic drinks. 

2. The Arteries of the human body may be classed as belonging to the 
system of (a) the pulmonary artery, or (b) to that of the aorta. 

The pulmonary artery (Plate V. 22) is a vessel the size and length of a 
thumb, which ascends perpendicularly from the right ventricle, along the 
left border of the sternum. It then divides into two branches, one for each 
lung. By means of this vessel, the dark red blood which is discharged into 
the heart by the vena cava , and which is poor in oxygen and rich in car¬ 
bonic acid, is carried to the lungs and again saturated with oxygen. The 
pulmonary artery is the only artery of the human body which carries dark 
blood. 

The aorta (Plate V 20) and all its branches, in contradistinction to the 
pulmonary artery, contain bright red blood, or blood rich in oxygen and 
poor in carbonic acid. At its origin the aorta has approximately the same 
thickness as the pulmonary artery, behind which it first runs upward and 
to the right. The succeeding portion describes a large curve, known as 
the arch of the aorta (Plate IV. 22), and then turns backward and down¬ 
ward through the chest and abdominal cavities. Opposite the fourth lum¬ 
bar vertebra, the aorta is divided into three terminal branches: the middle 
sacral artery (Plate V. 34) which runs downward in front of the sacrum, 
and the common iliac arteries (Plate V. 14, 33), two large lateral branches, 
which run toward the thighs. 

Throughout its course the aorta gives off a number of branches, the 
most important of which are the following: 

(1) The innominate artery (Plate V. 2) consists of a trunk, about as 
long and thick as an average middle finger, which soon divides into two 
branches: the right common carotid (Plate V. 1) and the right subclavian 
artery (Plate V. 3). The former runs upward to supply the head; the 
latter describes a large curve, enters the axilla between the clavicle and 
the first rib, and carries blood to the right arm. 

(2) The left common carotid (Plate V. 19) and (3) the left subclavian 
artery (Plates V. 21, and VII. 5) functionate like the corresponding arteries 
of the right side. 

(4) The intercostal arteries originate from the descending thoracic por¬ 
tion of the aorta, and run laterally in the spaces between the ribs. 









THE CIRCULATORY SYSTEM 


63 


(5) The lumbar arteries arise from the abdominal aorta, and run later¬ 
ally into the abdominal walls. 

(6) The two renal arteries (Plate V. 10, 29) are short but prominent 
vessels, which supply the two kidneys exclusively. 

(7) The mesenteric arteries (Plate V. 28, 32) are three unpaired vessels 
which run forward from the abdominal aorta, and carry blood to all the 
intestines. 

The common carotid arteries (Plate VII. 3) lie in the depressions on 
both sides of the larynx, and may be felt through the skin. At the level 
of the Adam’s apple each artery divides into the internal and the external 
carotid (Plate VII. 9, 10), the former for the brain and the latter for the rest 
of the head. A prominent artery of the head is the superficial temporal 
artery (Plate VII. 8), felt directly in front of the ear. 

When each subclavian artery has passed underneath the clavicle and 
entered the axilla, it is termed the axillary artery. Lower down this ves¬ 
sel descends along the mesial side of the upper arm, whereat is called the 
brachial artery. At the bend of the elbow this divides into two equally 
large branches, the ulnar and the radial arteries (Plate VIII. Fig. A. 3, 10), 
which descend to the palm of the hand along the ulnar and radial sides of 
the forearm respectively. They are here connected by two prominent 
arches (Plate VIII. Fig. A. 4, n), from which the arteries of the fingers 
take their origin. On account of these arches blood will spurt from both 
ends of the vessel, if either radial or ulnar artery be injured near the wrist. 

Both common iliac arteries (Plate V. 14, 33) divide, soon after their 
origin, into two branches: the internal iliac artery (Plate V. 15, 35) which 
runs into the true pelvis to supply the organs placed there, and the external 
iliac artery (Plate V. 16, 36) which descends next to the inlet of the pelvis, 
where it becomes the femoral artery (Plate VIII. Fig. B. 5) beneath Pou- 
part’s ligament. The beginning of the last-named vessel is very super¬ 
ficial just where it passes underneath the middle of Poupart’s ligament, 
and its pulsations can generally be felt with the fingers in the groin. The 
femoral artery continues its course along the mesial side of the femur 
to the popliteal space (the hollow at the back of the knee) where it is called 
the popliteal artery. At the lower end of this space it finally divides into 
the anterior and the posterior tibial arteries. The former takes its course 
between the extensor muscles on the front surface of the leg to the upper 
surface of the foot; while the latter runs along the back surface of the leg 
beneath the gastrocnemius, and then turns behind the mesial condyle to 
the sole. Like the corresponding vessels in the hand, the tibial arteries 
communicate in the foot by means of an arch so that the blood from one 
can flow into the other when either is severed. 

3. The Veins of the human body are much thinner and less elastic than 
the arteries. With the exception of the pulmonary veins, they also differ 




64 


THE STANDARD FAMILY PHYSICIAN 


from the latter in that they contain dark red blood, or blood poor in oxygen 
and rich in carbonic acid. The current of blood being much slower in 
the veins, stagnation is of frequent occurrence. T his can easily be demon¬ 
strated by allowing the hands to hang down, when the veins will show as 
bluish strands or network, especially on the back of the hands. If stagna¬ 
tion becomes excessive in any one area, the walls of the veins may lose their 
elasticity completely, and become permanently dilated so that they shine 
through the skin as bluish knots or very tortuous strands. Such dilated 
veins are known as varicose veins and frequently cause painful cramps. The 
veins of the human body are either superficial or deep; the former are 


Vena Cava 


-^\mona«7 



Aorta 




0 *iary Artery 

Fig. 57. Scheme of the circulation. 


visible under the skin, the 
latter accompany the cor¬ 
responding arteries. The 
following are the most im¬ 
portant veins of the human 
body: 

(i) The superior vena 
cava (Plate V. 4) lies behind 
the right edge of the sternum 
and carries the blood of the 
entire upper half of the 
trunk to the right auricle. 

(2) The inferior vena cava (Plate V. 12) is placed in the abdominal 
cavity, to the right and in front of the vertebral column. It collects the 
blood of the entire lower half of the body, then runs through the diaphragm, 
and also empties into the right auricle. 

(3) The portal vein is a very large vessel situated behind the pancreas 
and the duodenum. After collecting the blood from all the abdominal 
organs except the liver, it enters the latter organ at its lower surface. In 
the liver it splits up into a number of capillaries, which again unite, ulti¬ 
mately forming the hepatic veins which join the inferior vena cava at the 
posterior border of the liver. The circulation in the portal vein is con¬ 
siderably slower than in the other veins, since the blood has to force its 
way through the fine capillaries of the liver before it gets into the inferior 
vena cava. Stagnation is therefore very common in the portal vein, and 
if it affects the veins of the rectum it gives rise to Hemorrhoids. 

(4) The two right and the two left pulmonary veins are short but com¬ 
paratively thick vessels which empty into the left auricle soon after they 
leave the lungs. They are the only veins of the human body which con¬ 
tain bright red blood, rich in oxygen and poor in carbonic acid, their func¬ 
tion being to return the oxygenated blood from the lungs to the heart. 

The circulation of blood through the body takes place as follows: Start¬ 
ing from the left ventricle, the bright red blood is first carried into the 


























THE NERVOUS SYSTEM 


65 


aorta and then through its branches to all the organs of the body except 
the lungs. The oxygen is abstracted in the capillaries of the body and 
is used for the production of animal warmth, and for other metabolic func¬ 
tions. This process liberates carbon dioxid (C 0 2 ), which is absorbed by 
the capillary blood. The veins which succeed these capillaries therefore 
contain dark red blood, poor in oxygen and rich in carbonic acid. This 
blood is carried to the right auricle through both venae cavae, and then 
past the tricuspid valve to the right ventricle. From here it is propelled, 
by the closure of the tricuspid and the opening of the pulmonary valves, 
through the pulmonary artery to the lungs, in whose capillaries oxygen is 
absorbed and carbonic acid given off, so that the blood again assumes a 
bright red color. The succeeding course is through the pulmonary veins 
and left auricle into the left ventricle. From the left ventricle the blood 
again reaches the aorta to repeat the above course. As shown by the 
directions of the arrows in the accompanying cut (Fig. 57), the course 
described by the blood in its journey through the body is not a circle, but 
a figure “8” with its center at the heart. The entire time that it takes 
for a given blood-cell to complete this circuit is about twenty seconds. 

XI.—THE NERVOUS SYSTEM 

The nervous system is divided into: (1) The central organs; (2) the 
peripheral nerves; and (3) the sympathetic nerve. 

1. The Central Organs of the nervous system are the brain , contained 
in the skull, and the spinal cord , enclosed in the vertebral column (see Fig. 
47). On cutting into either organ, a white and a gray substance may be 
distinguished. The gray substance contains the nerve-cells which are in¬ 
timately associated with such mental processes as thought, perception, and 
volition; while the white substance is made up of the conducting tracts 
which may be likened to telegraph-wires connecting the nerve-cells with 
the organs of the body. In the brain the gray substance forms a narrow 
layer placed on the outside, while the white substance is placed in the inte¬ 
rior; in the spinal cord the opposite holds true. 

The human brain is divided into three great parts: (1) the cerebrum; 
(2) the cerebellum; and (3) pons and medulla. 

The cerebrum (Plate IX. 2, 6) forms the chief mass of the brain in 
man. Its gray, outer layer is the seat of intelligence and consciousness, of 
perception and volition. Recently, certain mental piocesses ha\c e\en been 
localized in definite, circumscribed areas of this layer, and certain parts 
of the brain are now designated as speech centers, "visual centers, and cen¬ 
ters governing the motions of the upper and the lower extremities. The 
destruction of one of these centers will result in the loss of the power of 
speech, or of sight, or of movement of the uppei or the lower extremities. 




66 


THE STANDARD FAMILY PHYSICIAN 


A deep impression running from the front backward divides the cerebrum 
into the left and right halves, or hemispheres. The division, however, is 
not complete, since both halves remain in communication by means of the 
so-called corpus callosum , which consists chiefly of fibers running from 
one half to the other (see Fig. 47). Owing to these fibers both hemispheres 
may functionate at the same time, or one hemisphere may vicariously 
assume the functions of the other when this is diseased or partially de¬ 
stroyed. The surface of the cerebrum has a peculiar appearance, owing 
to the presence of a number of furrows between which long elevations, the 
cerebral convolutions , are placed. 

The cerebellum (see Plate IX. 3; and Fig. 47) consists, like the cere¬ 
brum, of two halves; but these are not as sharply set apart from one an¬ 
other, and the furrows and convolutions on their surfaces are less curved. 
The cerebellum contains nerve-cells, many of which preside over asso¬ 
ciated movements. 

The pons and the medulla oblongata form the transition between the 
brain and the spinal cord. The medulla oblongata (Fig. 47. 13) may thus 
be regarded as the uppermost portion of the spinal cord, which projects 
into the skull. It contains the nerve-centers for respiration, for the heart 
and blood-vessel mechanism, and for many of the cranial nerves. The 
medulla therefore contains the most vital nerve-centers of the body. 

The spinal cord (Plate IX. 4, 5) is a cylindrical structure, which breaks 
up into a number of nerve-strands in the region of the lumbar vertebrae. 
The outer, white substance is made up of those nerve-fibers which, issuing 
from the cerebrum and the cerebellum, run downward through the pons, 
the medulla, and the spinal cord. The internal, gray substance contains 
those nerve-cells which preside over the functions of the voluntary muscles, 
particularly their reflex activity. They also serve as important centers for 
the movements of the bladder, rectum, intestines, etc. 

Both brain and spinal cord are enclosed in a number of membranes, 
among which the dura mater (Plate IX. 1) is the most superficial, and the 
best developed. 

2. The Peripheral Nerves. As previously stated the fibrous prolonga¬ 
tions of the nerve-fibers, issuing from the central body of the nerve-cells, 
constitute the white substance of the brain and of the spinal cord. Col¬ 
lected into large strands they reach the surface of the body. Through 
constant subdivision the branches become finer and finer, and eventually 
terminate in end-organs (see p. 14). The nerves are called cerebral or 
spinal, depending upon whether they take their origin in the brain or in 
the spinal cord. 

The cerebral, or cranial, nerves, form twelve pairs, which take their 
origin from the lower surface of the brain, or medulla, and emerge 
through the openings at the base of the skull. Important among these are 







THE NERVOUS SYSTEM 


67 


the nerves of special sense, namely the nerves of smell (first), sight (second), 
hearing (eighth), and taste (twelfth). It has already been stated that each 
is capable of transmitting only one special sense. Another important 
nerve is the fifth, or trigeminal nerve , so called because soon after its origin 
it subdivides into three large branches (Plate XI. i). Its chief function 
is to transmit painful sensations. The first branch runs into the orbit, 
and thence upward upon the forehead (Plate XI. 14); the second supplies 
chiefly the upper jaw and the upper teeth (Plate XI. 15); and the third, 
the lower jaw with its teeth (Plate XI. 16). The pain-transmitting nerves 
of the skin of the face are also derived from the trigeminal nerve. All 
three branches are frequently the seat of a disease (so-called neuralgia ) 
marked by paroxysms of pain; toothache involves one of the branches of 
this nerve. The tenth nerve, which is called the pneumogastric or vagus 
nerve (Plate XI. 3, 18, 20, 22, 23) describes the longest course of any of the 
cranial nerves. It is first placed next to the large vessels of the neck, then 
runs downward along the esophagus, and supplies finally the stomach and 
the intestines. The pharynx, larynx, esophagus, trachea, lungs, heart and 
stomach are innervated by twigs from this nerve. 

The spinal nerves form thirty-one pairs which originate from the side 
of the spinal cord and emerge through the openings between the vertebrae 
(Plate IX.). From these arise the sensory and motor nerves of the rest 
of the body. After passing through the intervertebral openings they gen¬ 
erally form coarse networks (or plexuses ), and then break up into larger 
and smaller branches. Prominent plexuses are the cervical plexus (Plate 
X.) and that formed by the intercostal nerves (Plate XI. 7). The thickest 
nerve-strands are formed by the brachial plexus (Plate XI. 6), and by the 
lumbar and sacral plexuses. The first-mentioned gives rise to the nerves 
for the upper extremities, the other two to those of the lower limbs. A 
particularly prominent branch of the sacral plexus is the sciatic nerve. It 
runs along the back of the entire lower extremity to the sole of the foot; 
and it is well known also to the laity, since it is often the seat of a very 
painful disease (Sciatica). 

3. The Sympathetic Nerve (Plate XI. 4, 8, 9) occupies a special place 
among the nerves of the human body since it consists chiefly of nerve- 
fibers in whose course many nerve-cells are interpolated. The principal 
trunk of the nerve (Plate XI. 4? 8 ) runs downward along the spine fiom the 
skull to the coccyx; and throughout its course it shows many nodular 
swellings consisting of nerve-cells. This principal trunk may be regarded 
as a third central nervous organ. By means of delicate fibers it stands 
in indirect communication with the brain and the spinal cord, and its 
branches surround the neighboring arteries, together with the branches of 
which they reach almost all organs of the human body. The belief that 
this nerve established sympathy between the organs gave rise to its name. 





68 


THE STANDARD FAMILY PHYSICIAN 


The branches of the sympathetic nerve supply the many smooth muscle- 
fibers of the human body. It has already been stated that these smooth 
muscle-fibers are involuntary, and that they therefore contract without be¬ 
ing influenced by the will. As examples may be mentioned the contraction 
of the small vessels of the skin, and contraction of the stomach, intestines, 
and pupils. Although the sympathetic nerve exerts its function without, 
or even against, the will, it is to a certain degree dependent upon the brain 
and spinal cord, owing to the communicating fibers already mentioned. It 
is for this reason that contraction of smooth muscle-fibers may follow cer¬ 
tain mental processes, causing, for example, pallor after fright or fear, 
and fainting from acute pain, the latter being often due to a sudden con¬ 
striction of blood-vessels and consequent loss of blood in the brain. 


XII.—THE ORGANS OF SPECIAL SENSE 

The organs of special sense are: (i) The eye; (2) the ear; (3) the organ 
of smell; (4) the organ of taste, placed in the mucous membrane of the 
tongue; and (5) the organs of touch, placed in the skin. Only the eye 
and ear will be described in detail here. 

1. The Eye is the organ of sight. It lies in the orbit, and consists of 
the eyeball and its accessory parts, which latter either serve to rotate the 
eyeball or to protect it (see Figs. 58, 59). 

The motor apparatus of the eye includes a number of muscles which 
act either singly or together, thus permitting of considerable freedom of 
motion. If one of these muscles becomes paralyzed, the muscles acting 
in its opposite direction will give rise to Squinting. The muscles of the 
eye are regulated by the third, fourth and sixth cranial nerves. 

The protective organs of the eye are the eyebrows, eyelashes, eyelids 
and the lacrimal apparatus. The eyebrows protect the eye from the per¬ 
spiration of the forehead; the eyelashes keep out irritating rays of light 
and small foreign bodies such as insects or dust. The eyelids are two 
movable curtains which are reinforced by two crescent-shaped pieces of 
cartilage. Behind, the eyelids are covered by a reddish mucous mem¬ 
brane, the conjunctiva , which forms a pocket and then turns over the outer 
surface of the eyeball itself. Particles of dust and coal are frequently 
caught in this pocket, and give rise to disagreeable irritation. If the lower 
eyelid is pulled downward, the shiny red conjunctiva may be inspected 
without difficulty. The so-called Meibomian glands are placed in the car¬ 
tilages of the eyelids, where they elaborate a fatty secretion which reaches 
the surface at the free borders of the lids. The chief function of the lids 
themselves is to moisten the front surface of the eyeball, and thus prevent 
drying of the cornea of the eye. The chief lacrimal organ is the lacrimal 
gland , which is placed in the upper lateral corner of the orbits and secretes 









THE ORGANS OF SPECIAL SENSE 


69 


the tears. These pass between the eyelids and the eyeballs to the inner 
angle of the eye, then through the lacrimal canals into the lacrimal sac, 
and finally into the nasal duct which runs downward along the mesial 
wall of the orbit, connecting the latter with the nasal cavity (see Fig. 58, g). 
All the tears thus reach the^nose; and 
with abundant secretion, as after crying, 
it may be necessary to blow the nose 
frequently. 

The eyeball consists of special refrac¬ 
tion lenses supported by membranes. 

The latter are: (1) The sclerotica with 
its continuation, the cornea; (2) the 
choroid with its continuation, the iris; 
and (3) the retina , which is prolonged 
forward as the capsule of the lens. The 
sclerotic coat forms the “white of the 
eye,” which shines through the conjunc¬ 
tiva. In front, it becomes the cornea, a 
perfectly transparent layer which does b ' i^ujniwhh "anspa^mmS^); £ sde’ 

. . c r t i , rotica; c, conjunctiva; p, p\ upper and lower 

not interfere with the passage ol light. entrance to tear-ducts; r, r', upper and iower 

, i • . lacrimal canals; t , tear-sac; g, tear-duct. 

I he choroid coat and its continuation 

lie internal to the sclerotica and are abundantly supplied with pigment- 
granules and blood-vessels. The iris is easily visible through the trans¬ 
parent cornea, and is differently colored in different individuals. Normally 
it may show all shades between gray, blue, yellow and black. In the iris 

of albinos, as in their hair and 
skin, there is a complete ab¬ 
sence of color, so that the fine 
blood-vessels shine through and 
give rise to a reddish tinge (see 
Albinism). In the center of the 
iris is an opening, the pupil , di¬ 
rectly behind which the front 
surface of the crystalline lens 
is placed. The function of the 
iris is to protect the eye from an 
excess of light so as to enable 
distinct vision. For this reason it 
is supplied with smooth muscle- 
fibers which cause the pupil to 
contract or dilate. When bright 
light falls into the eye, a contraction occurs in order to diminish the supply 
of light; but in the dark the pupil becomes large, so that as much light as 



1, cartilage of the eyelid; 2, orbicularis muscle; 3, external 
skin; 4, iris; 5, anterior chamber of eye; 6, posterior 
chamber; 7, muscle of lens; 8, conjunctiva sac; 9, con¬ 
junctiva; 10, retina; 11, choroid; 12, sclerotica. 



Fig. 58. The eye seen externally. 










70 


THE STANDARD FAMILY PHYSICIAN 


possible may enter the eye. In the most anterior, thickened portion of the 
choroid there is a special muscular band, the ciliary muscle , which adjusts the 
shape of the crystalline lens for vision at different distances. The soft, 
brownish retina is placed internal to the choroid. It is made up chiefly 
of the expansion of the optic nerve whose end-organs are very small nervous 
bodies, some of which are known as the rods and cones. 

The light-refracting portions of the eye, excluding the cornea, are divided 
into (i) aqueous humor; (2) crystalline lens; and (3) vitreous humor. 
The aqueous humor is a watery solution of albumin, filling up the space 
between the cornea and the crystalline lens. This space is divided by the 
iris into two parts: a large anterior, and a small posterior chamber of the 
eye. The crystalline lens has the shape of a strongly bi-convex lens, and 
consists of a firm but elastic substance which can change its degree of 
convexity as the ciliary muscle contracts. The outer surface of the lens 
is surrounded by a transparent membrane (the capsule of the lens) which 
is attached to the choroid, and which follows all changes in shape on the 
part of the lens. The largest part of the eyeball is occupied by a jelly- 
like, transparent substance, the vitreous humor , which extends from the 
back of the lens to the retina. 

The perception of light is due to the fact that the rays of light pass 
through the cornea, anterior chamber of the eye, lens, and vitreous humor, 
finally reaching the rods and cones of the retina, which are stimulated. 
By way of the optic nerve this stimulation is transmitted to the visual cen¬ 
ter in the brain, where it gives rise to the sense of sight. In passing through 
the lens, the light-rays are refracted so that a small, sharp image is formed 
upon the retina. The normal curvature of the lens enables the formation 
of a clear image of a distant object. When an object close at hand is viewed, 
the contraction of the ciliary muscle increases the curvature of the lens so 
that the rays of light are refracted from a greater angle in order to form 
a distinct picture on the retina. In old age the lens generally loses its elas¬ 
ticity, and the eyeball flattens somewhat, so that the eye is adjusted only 
for far vision. In this condition, which is known as far-sightedness, objects 
at a distance may be seen clearly, while convex eye-glasses are required 
for near vision. An opposite condition is near-sightedness. This results 
when the image normally forms in front of the retina, and it becomes neces¬ 
sary for the patient to bring his eyes close to the object, thus spreading 
the angle of the incoming rays so that they will be thrown further back 
and on the retina itself. Short-sighted individuals must wear concave 
lenses which will spread the incoming rays and bring them to a focus 
further back in the eye (see Eye, Diseases of). 

2. The Ear is the *>rgan of hearing, and consists of three parts: (1) 
The external ear, (2) the middle ear, and (3) the internal ear (see Fig. 60). 
The greater part of this system is enclosed within the temporal bone. 








THE ORGANS OF SPECIAL SENSE 


The external ear includes the auricle and the external auditory canal 
the opening of which is visible at the bottom of the former. The auricle 
is supported by the elastic cartilage of the ear; but its lowermost portion, 
the lobule of the ear, is merely a fold of skin padded with fat. The ex¬ 
ternal auditory canal is surrounded externally by cartilage, and internally 
by bony walls; it ends at the drum-membrane, the partition between the 
external and the middle ear. The lining of the canal resembles the skin, 
and contains the so-called ceruminous glands which secrete a peculiar yellow¬ 
ish or dark-brown sub¬ 


stance, the ear-wax. In 
some individuals this ear- 
wax accumulates to such 
an extent that it blocks 
up the ear canal and 
may cause deafness. The 
drum-membrane is a cir¬ 
cular, white membrane, 
placed obliquely, so that 
it forms an acute angle 
with the lower wall of the 
external auditory canal. 

The middle ear, or 
tympanic cavity, is a 
small space which may be 
compared to a tambour¬ 
ine placed somewhat ob¬ 
liquely on its edge. The 
lateral wall is formed by the drum-membrane; the mesial wall, by the 
bony labyrinth (see following paragraph). Both walls are separated by a 
space only one-twelfth to one-eighth of an inch wide, which contains the 
three bones, or ossicles , of the ear: the malleus , the incus , and the stapes. 
These bones are connected by means of joints, so that they really form a 
chain of three links. The handle of the malleus is inserted into the drum- 
membrane; the incus is joined to the malleus, and the stapes to the incus. 
The plate of the stapes fits into an oval window in the labyrinth. In front 
and internally the middle ear communicates by means of the Eustachian 
tube with that portion of the pharynx which is situated behind the nose. 
From this it follows that if the drum-membrane is perforated, smoke may 
be blown into the middle ear through the Eustachian tube, and thence, 
through the opening in the membrane, out into the external auditory canal. 

The internal ear, or labyrinth, is divided into a bony and a membra¬ 
nous portion. The bony labyrinth is a thickened portion of the temporal 
bone, and may be chiseled out of the latter; it contains a clear, pale fluid. 


Fig. 6o. The organs of hearing (partly schematic). 

i, the three semi-circular canals; 2, vestibule; 3, cochlea; 4, groove 
for the auditory nerve; 5, stapes; 6, incus; 7, malleus; 8, the 
tympanic cavity with the ossicles. 





























72 


THE STANDARD FAMILY PHYSICIAN 


The membranous labyrinth is located within the bony labyrinth, and re¬ 
sembles the general shape of the latter; the end-organs of the auditory 
nerve terminate in its walls. The bony labyrinth consists of three parts: 
(i) The vestibule; (2) behind this, the three semi-circular canals; and (3) 
in front of it, the cochlea. The membranous labyrinth is made up of a 
system of very thin-walled tubes and sacs which are also filled with fluid. 
The endings of the auditory (eighth) nerve upon its inner walls show a 
very complicated structure. The terminal organs are the so-called audi¬ 
tory cells , the free margins of which are covered with fine hairs. 

Perception of sound takes place in the following manner: The sound¬ 
waves enter the external auditory canal and produce vibrations in the 
drum-membrane. These vibrations are transmitted along the chain of 
ossicles to the vestibule of the labyrinth, and thence along the semi-circular 
canals and the convolutions of the cochlea to the round window of the 
labyrinth, which is closed by a thin membrane. Every sound-wave causes 
this membrane to bulge out toward the middle ear. As the waves travel 
through the labyrinth they irritate the hair-cells; and this irritation is 
transmitted through the auditory nerve to the center of hearing in the 
brain, where it is perceived as sound. Every musical note seems to have 
a corresponding auditory cell, which is stimulated when that particular note 
is transmitted through the labyrinth. 

XIII.—THE ORGANS OF GENERATION 

The form of reproduction by which the human beings, as well as all 
higher animals, propagate, is a very complicated one which requires dis¬ 
tinct organs of generation in the two sexes. The female organ generates 
the so-called ovum , or germ-cell, while the male organ develops the impreg¬ 
nating element called spermatozoon. From the union of these two elements 
results the new organism which during its uterine existence is nourished by 
a temporary organ, the placenta. The placenta consists of an arrangement 
of vessels which connect the maternal blood-vessels with the fetus through 
the umbilical cord. Immediately after the expulsion of the fetus the pla¬ 
centa is detached from the wall of the uterus, forming the larger part of the 
afterbirth. The following paragraphs contain detailed descriptions of the 
generative organs in both sexes: 

The male organs of generation are the penis, the testicles and their 
ducts, the prostate gland, the Cowperian glands, and the seminal vesicles. 

The penis consists of three somewhat flattened cylindrical masses of 
spongy tissue, containing numerous blood-spaces and capped by the conical 
glans. The two upper masses are placed side by side and are called the 
cavernous bodies. At the root of the penis these bodies separate, and run 
downward and outward along the pelvic bone. The third mass of tissue 









THE ORGANS OF GENERATION 


73 


is called the spongy body and is situated on the lower surface of the penis. 
Anteriorly it expands into the head, or glans, and internally terminates just 
within the body in another expansion called the bulb. The glans is a pyra¬ 
midal body, flattened from above downward. Its projecting circumference 
is known as the corona. About the corona are situated many sebaceous 
glands, which secrete a modified sebaceous substance, the smegma. At the 
anterior extremity of the glans is the orifice of the urethra, or lumen of 
the penis; and just below this, between the glans and the under surface of 
the penis, is a little fibrous band, known as the jrenum glandis. The skin is 
reflected from behind the corona down over the glans to form the prepuce 
or foreskin. The skin of the penis contains no fat. 

The urethra runs through the spongy body. It is lined with mucous 
membrane, and is surrounded by a small amount of muscular tissue. Back 
of the bulb it is somewhat constricted in passing through a double fibrous 
membrane, the triangular ligament , and then continues through the prostate 
to the bladder. The mucous membrane of the urethra is continuous with 
that lining the various genital glands and ducts, and through the bladder 
with the upper urinary tract. 

The Cowperian glands , or Cowper’s glands, are two small yellowish 
bodies about the size of peas, placed just in front of the prostate, between 
the two layers of the triangular ligament, at which point they empty into 
the urethra. They are composed of minute lobules arranged somewhat 
like a bunch of grapes, and secrete a fluid which contributes to the seminal 
discharge. 

The prostate gland is a firm glandular body, somewhat the shape of a 
chestnut, placed immediately in front of the neck of the bladder and around 
the commencement of the urethra. Its base is about an inch and a half in 
diameter, and is directed upward and backward toward the bladder, the 
apex pointing downward and forward. It is about an inch behind and be¬ 
low the anterior bony border of the pelvis, while its posterior surface can 
easily be felt through the rectum. It is composed of three lobes: two 
lateral ones which unite in front, and a smaller central lobe which is situ¬ 
ated beneath the neck of the bladder and behind the urethral orifice. The 
gland is made up of involuntary muscular tissue, and of numerous secreting 
follicles which are drained by a system of tubules and empty through twelve 
to twenty little ducts opening into the urethra. The secretion of the pros¬ 
tate also forms part of the spermatic fluid. 

The testicles are highly specialized glands which secrete the essential 
part of the seminal fluid. They are oval bodies, somewhat compressed 
laterally, and are suspended in the scrotum by the spermatic cords. T he 
left testicle hangs somewhat lower than the right, its spermatic cord being 
i a little longer. Each testicle is enclosed within a dense fibrous capsule and 
is surrounded, except posteriorly, by a sack (the tunica vaginalis) which 









74 


THE STANDARD FAMILY PHYSICIAN 


contains a small amount of lubricating fluid, so that it is freely movable 
within the scrotum and is thus less liable to injury. Between this sack and 
the skin are four layers of tissue, more or less intimately united, which divide 
the scrotum into tw T o cavities for the two testes. One of these layers, the 
cremasteric jascia , is largely composed of muscle-fibers, and to this is due 
the power of the scrotum to retract under certain conditions. 

The fibrous capsule enveloping the testicle sends processes into the gland, 
dividing it into many lobules. Each of these lobules contains several minute 
secreting tubules, from whose lining originates the spermatozoon , the male 
cell necessary to fertilization. These tubules are drained by a rather com¬ 
plicated system through the epididymis , a small organ situated on the 
posterior aspect of the testicle, into the vas deferens. The vas deferens is a 
tube which ascends as part of the spermatic cord, and passes through the 
abdominal wall to the base of the bladder. 

The spermatic cords are composed of the vas deferens, blood-vessels, 
lymphatics and nerves, and a thin fibrous cord. The most noticeable con¬ 
stituent is the convoluted mass of veins. As the vasa efferentia near the 
urethra they are joined by the ducts of two slender membranous pouches, 
called the seminal vesicles. These pouches are about two inches in length 
and are situated between the base of the bladder and the rectum. They 
serve as reservoirs for the semen, and contribute more or less fluid to that 
mixture. The vasa and seminal vesicles on each side, joining, form the 
ejaculatory ducts , which run through the prostate for about three-quarters 
of an inch, to discharge their contents into the urethra. 

The female organs of generation may best be treated under two headings, 
the external and the internal organs. The external organs are known under 
the term vulva , and include the mons Veneris, labia majora, labia minora, 
clitoris, vestibule, hymen, and fourchette. 

The mons Veneris is a slight elevation composed of fat, which is situated 
over the anterior junction of the pelvic bones. Below this point two prom¬ 
inent folds of skin are seen extending backward and diverging slightly. 
These are the labia majora. They unite in front forming the anterior 
commissure. Posteriorly they diminish in size, and disappear in the sur¬ 
rounding tissue without meeting or coming to an abrupt end. The line 
connecting their posterior extremities is spoken of as the posterior com¬ 
missure. The outer surfaces of the labia majora are not unlike the skin in 
other localities, but the inner surface and all structures enclosed by them 
are smooth and pinkish. Overhung by the labia majora are two smaller 
folds of skin known as the labia minora. These also start at a common 
point anteriorly and diverge posteriorly. 

At the anterior junction of the labia minora is situated the clitoris. This 
organ is analogous to the penis in the male. It is composed of spongy 
erectile tissue and sends processes corresponding to the cavernous bodies 






THE ORGANS OF GENERATION 


75 


down along the arms of the pelvic bones. The anterior extremity of the 
labia minora forms the frenum clitoridis. The glans is often hidden from 
view by the prepuce. A venous plexus corresponding to the spongy body 
of the penis underlies the labia minora. Anterior to the orifice of the vag¬ 
inal canal is a triangular area, bounded laterally by the labia minora. This 
is called the vestibule. The orifice of the urethra is situated about in the 
center of this triangle. 

Just posterior to the vaginal orifice is a slight boat-shaped depression 
called the jossa navicularis. The space between this depression and the 
anus constitutes the perineum, its anterior edge being called the jourchette. 
The orifice of the vagina is partly occluded by a membranous structure 
called the hymen. Behind the hymen, on either side of the vagina, lies a 
small gland about the size of a bean. These are the vulvo-vaginal glands. 
Their ducts empty just externally to the hymen. 

The internal organs of generation in the female are the vagina, the 
uterus, the Fallopian tubes, and the ovaries. 

The vagina is a canal extending from the vulva upward and backward 
to the uterus. Its anterior wall is about two and one-half inches in length, 
and the posterior wall three and a half inches. It is lined with modified 
skin which much resembles mucous membrane, and which contains nu¬ 
merous mucous crypts. The surface is interrupted by transverse ridges 
and small conical projections. Surrounding this inner layer are many 
large veins, forming a plexus which acts more or less as erectile tissue. The 
layer of veins is enclosed in a muscular coat composed of an inner circular 
and an outer longitudinal layer of involuntary muscle. Surrounding the 
lower end is a band of voluntary muscle. The vagina is situated between 
the bladder and urethra in front and the rectum behind, and pierces the pow¬ 
erful levator muscle—the sling of the pelvis upon which so much depends 
for support. 

The uterus, or womb, is a hollow muscular organ, somewhat pear-shaped 
and flattened anteroposteriorly. It is about three inches long, two inches 
broad at its upper end, and an inch thick. Although quite movable, its 
usual position is with its top tipping forward, just below the brim of the 
pelvis,* and the lower part inserting into the vagina at an angle of about 
90 degrees. By a slight constriction it is divided into two parts, the body 
or fundus being above and the neck or cervix below. The lower part of the 
cervix protrudes into the vagina, and has at its apex a small aperture, the 0s 
or mouth of the uterus. The cavity of the uterus is triangular in shape and 
flattened from before backward. The opening of the cervix is spindle- 
shaped, being constricted at each end. The junction of the cervical canal 
and the cavity of the uterus is called the internal os. At the upper corners 
of the uterus the cavity connects by two very small openings with the Fallo¬ 
pian tubes. 





76 


THE STANDARD FAMILY PHYSICIAN 


The uterus is lined with true mucous membrane. At the lower portion 
of the cervix the cells are flat or squamous epithelium arranged in layers. 
In this locality there are numerous short mucous crypts which often become 
occluded and, filling up with their own mucoid secretion, form little cysts. 
The upper half of the cervical canal and the cavity of the uterus are lined 
with what are known as ciliated columnar cells. On the surface of these 
cells are many little hairlike processes, or cilia, which are in constant motion. 
Waves of movement sweep rapidly over the entire surface like grain bending 
before the wind. This produces a current in the direction of the cervical 
outlet. The mucous membrane contains many deep tubular glands, also 
lined with ciliated cells. 

The greater part of the uterus is made up of involuntary muscle of 
rather complex arrangement, and very rich in blood supply. For three- 
quarters of its extent in front, and completely behind, it is covered by the 
lining membrane of the abdomen, the peritoneum. The uterus is supported 
and held in position by eight so-called ligaments. All these, except the two 
round ligaments, are folds of the peritoneum. The peritoneal fold turning 
up from the anterior surface of the uterus over the bladder is the vesico¬ 
uterine pouch; posteriorly, as the peritoneum is reflected over the rectum, 
it forms the rectouterine ligament. Between the uterus and the rectum is a 
peritoneal pouch whose lateral walls form the sacrouterine ligament. The 
uterus is connected laterally with the pelvic walls by folds of peritoneum 
called the lateral ligaments. Together with these lateral ligaments the uterus 
thus forms a transverse partition, dividing the pelvis into two parts. The 
bladder and urethra occupy the anterior part, while the rectum fills the pos¬ 
terior part. 

Between the two layers of the broad ligament are situated the round 
ligaments, the Fallopian tubes, the parovarium, muscular and fibrous tissue, 
and vessels and nerves. The round ligaments are two fibrous and muscular 
cords within the lateral ligaments. They begin near the superior angle of 
the uterus and pass upward, outward, and forward to the abdominal wall. 
This they penetrate like the spermatic cord in the male, and insert in the 
tissue of the labia majora. They are four or five inches in length. 

Along the upper free borders of the lateral ligaments lie the Fallopian 
tubes. Each tube is about four inches in length, and extends outward from 
the upper angle of the uterus toward the lateral pelvic wall, its free end 
drooping down over the ovary which lies beneath the tube on the posterior 
surface of the lateral ligament. The inner portion of the tube is quite 
constricted, but it enlarges as it passes outward. The end is surrounded 
by finger-like processes, the firnbrice, one of which is attached to the ovary. 

The tube is lined with ciliated cells. At its outer end it opens into the 
peritoneal cavity and at its inner end into the cavity of the uterus, so that 
through the tube, uterus, and vagina, there is a direct communication from 







THE ORGANS OF GENERATION 


*77 


the abdominal cavity to the outer world. It is through this channel that 
the female germ-cell, or ovum, passes, after having been thrown off by the 
ovary. Propelled through the tube by the ciliary action of its lining cells, 
it may eventually meet the male cell and develop within the uterus, or else 
pass off through the vagina with the menstrual discharge. Surrounding 
the mucous membrane of the tube are two layers of muscular tissue, an 
inner circular and an outer longitudinal layer. This muscle is continuous 
with that of the uterus. The tube is enveloped, except at its free end, by 
the peritoneum. 

The parovarium , or epoophoron, is a small tubular structure in the 
lateral ligament. It is the remains of a fetal organ, and has no practical 
significance in the healthy adult. 

The ovaries correspond to the testicles in the male. They are flattened, 
oval bodies about an inch in length, situated on either side of the uterus, on 
the posterior surface of the lateral ligaments. They are attached to the 
uterus by a short ligament arising from its lower end, and are enclosed in a 
reflection of the peritoneum from the lateral ligament. In appearance this 
covering is, however, somewhat different from the ordinary peritoneum, 
being a dull gray in color. 

The substance of the ovary is largely loose, soft, connective tissue, rich 
in blood supply. The tissue is condensed at the periphery into a firm cov¬ 
ering. The outer third of the ovary is called the cortex , the central part 
the medulla. Scattered through the tissue of the cortex are numerous little 
globules, varying from to J of an inch in diameter. These are the 

Graafian jollicles , the homes of the immature ova. As the ovum matures, 
certain changes take place in the Graafian follicle, which gradually enlarges 
until its diameter includes almost the entire cortex. It finally forms a pro¬ 
jection on the surface of the ovary and bursts at this point, allowing the 
mature ovum to escape and find its way into the fibrinated extremity of the 
tube. This usually coincides with the period of menstruation. 

Beside the Graafian follicles the ovary contains little yellow bodies in 
various stages of development. These are the remains of the Graafian 
follicles that have discharged their contents and are undergoing degenera¬ 
tive changes. 






GENERAL REMARKS ON DISEASE 


I.—NATURE OF DISEASE 

Any departure from the normal performance of natural functions is 
defined as disease. The abnormal variations may be so very evident that 
even a layman may detect them at a glance. External injuries are very 
easily diagnosed; and even internal ones may often be readily recognized, 
as when foreign matter, such as blood, is passed from the nose, ear, or 
intestines. Abnormalities in the shape of organs (swelling, thickening, 
curvature, induration, atrophy, etc.) may also be very noticeable, if they 
have not existed before. The functions of the different organs may also 
be accompanied by marked disturbances, such as cough and expectoration, 
vomiting, diarrhea, shortness of breath, increased body-temperature, con¬ 
vulsions, delirium, etc. 

On the other hand, an individual may be sick in spite of the fact that 
nothing morbid may be detected at examination. Certain affections are 
not accompanied by marked changes in the organs, and manifest them¬ 
selves only at certain intervals. Epilepsy, for example, attacks at intervals 
of a month or more; and gall-stones are accompanied only by occasional 
paroxysms of pain when a stone is caught in the passages. This stone 
can not always be detected by the common methods of examination. 

Disease always relates to a disturbance of the functions of body or mind, 
although such disturbance may be apparent only under certain conditions. 
The underlying cause of disease is some abnormality in the organic struc¬ 
ture and functions; and every disease is dependent upon changes in the 
physiological workings of some special organ or organs. In very many 
instances the disease remains restricted to one particular organ; and vari¬ 
ous diseases are therefore classified and described according to the organs 
affected. Distinction is thus made between diseases of the skin, of the 
muscles, of the bones, the nervous system, the lungs, the heart, the blood¬ 
vessels, the kidneys, the genito-urinary apparatus, and the digestive organs, 
etc. 

The seat of disease may be localized even still more accurately in many 
instances, since it can almost invariably be determined which part of the 
organ is particularly involved. In the case of a cold in the nose, for instance, 
the cells of the nasal mucous membrane are converted into mucus and are 
thrown off, while the blood-vessels secrete a thin, watery or purulent fluid. 










NATURE OF DISEASE 


79 


In that form of tumor which is known as sarcoma, the cells common to 
connective tissue continue to increase in number until large growths result. 
These push aside normal structures of the body, and may eventually cause 
death if they spread in important vital organs. In cancer of the stomach, 
the cells of the mucous membrane of that organ proliferate in a like man¬ 
ner, forming more or less firm swellings which may block the entrance to 
the intestines. Constant vomiting, and death by starvation may be the 
consequence. The peculiar disease known as leucocythemia is a result of 
an affection of the blood-forming organs (bone-marrow and spleen), which 
causes an enormous increase in the number of white corpuscles; in severe 
cases, decrease in number and alteration in shape of the red cells will follow. 

That many diseases are of local origin is a theory which is in perfect 
accord with the experience gained at autopsies, operations, during micro¬ 
scopical examination of organs, and while observing the course of affec¬ 
tions. An impoverished condition of the blood is usually not the cause, 
but the consequence of illness, and in the majority of cases it does not play 
a prominent part. Charlatans, natural healers, etc., still regard the humors 
of the body as being of great importance; not because they have any proofs 
to support their views, but because they don’t know any better. If one 
be guided by facts and not by conjectures, the local origin of disease must 
be conceded. It will then be evident that a careful examination of the 
different organs is absolutely necessary in order to detect the seat of the 
disease and to treat it properly. For this purpose, a knowledge of the 
anatomy of the organs in health and disease, and experience in the more 
difficult methods of examination (ophthalmoscopy, laryngoscopy, etc.) are 
essential. 

The fact that two or more diseases may affect the same body simul¬ 
taneously, is another illustration of the local character of disease. It is 
possible for an individual to suffer at one and the same time from con¬ 
sumption, gall-stones, and ulcer of the stomach; or to be attacked simul¬ 
taneously by dyspepsia, gout, and stones of the kidney. It is therefore diffi¬ 
cult to understand how Hahnemann, the father of homeopathy, could state 
that all diseases are general, not local, and that two diseases can not invade 
the same body at the same time. Almost every autopsy convinces one of 
the absurdity of this view. Equally ridiculous theories are ad\ anced b^ 
many quacks. Some of them state, for instance, that every disease is due 
either to disturbances in the circulation of the blood 01 to a change in its 
composition. In order to cure disease the blood must be made to circu¬ 
late properly, or the impure substances must be excreted. 

The danger of such sweeping statements can be seen from the following 
example. In order to win a bet some individual eats an enormous meal 
and drinks an excessive amount of beer. Extreme distention of the ab¬ 
domen follows, and the patient becomes seriously ill. True to his theory, 









80 


THE STANDARD FAMILY PHYSICIAN 


the quack who has been hurriedly summoned directs his attention to the 
disturbed circulation and to the noxious products which are supposed to 
clog the blood. He may order applications to the abdomen “to stimulate 
excretion,” or foot-baths “to cause depletion,” and perhaps an enema of 
a certain size and temperature “to remove the excess of food.” This treat¬ 
ment will most likely be fatal to the patient. A physician, on the other 
hand, will try to discover the seat of the disease and treat it accordingly. 
His experience in examination soon convinces him that only something in 
the stomach could cause such enormous distention of the abdomen. He 
remembers from his anatomical studies that over-filling of the stomach 
closes that organ both toward the esophagus and the duodenum. The 
stomach is therefore unable to relieve itself either by spontaneous vomiting 
or by propulsion of the food toward the intestines; and the condition of 
the patient must rapidly grow worse, owing to fermentation of the gastric 
contents. The physician therefore at once introduces a stomach-tube and 
washes out the stomach so as to rid it of all injurious matter. The patient 
is fed by the rectum for one or two days, so that the over-distended stom¬ 
ach may return to its normal state. At the end of this time the patient 
will have recovered. Here treatment of the local disease—acute dilatation 
of the stomach—will save the patient’s life; whereas he who bases his treat¬ 
ment on the idea that the general pallor, the cold perspiration, and the 
rapid pulse are due to a disturbance of circulation (which is the conse¬ 
quent 3 , and not the cause of the condition) will kill the patient. 

Another example may be mentioned: An exceedingly pale and weak 
individual consults a natural healer who advises him to eat fruits and green 
vegetables, and to take sun-baths, general massage, etc., in order to im¬ 
prove the blood. The patient’s anemic condition, instead of improving, 
steadily grows worse. The physician who is now summoned endeavors to 
determine the cause of the impoverished condition of the blood. On ex¬ 
amining the stool of the patient with a microscope he soon detects the eggs 
of a certain kind of tape-worm. This worm may be expelled by proper 
remedies, and the patient will recover without further treatment. Nobody 
can therefore doubt that the nature of a disease determines the course of 
treatment; and the same remedies can never apply to all cases. And it is 
equally as ridiculous to attribute all ills to humors or to deteriorated blood. 

Certain diseases, however, affect the greater part of the body, even all 
the organs, through the blood or the lymph. When, for example, a per¬ 
son attempts suicide by drinking carbolic acid, the mucous membranes of 
the mouth, esophagus, and stomach are first intensely burned, whereupon 
a severe catarrh sets in. The poison is then taken up by the blood-vessels, 
so that it reaches all organs, causing changes in them that interfere with 
their proper functions; and as a result of the loss of these functions the 
patient dies. An accumulation of pus may, likewise, find its way into the 








CAUSES OF DISEASE g! 

blood, so that the germs which cause the suppuration reach other organs 
and form new collections of pus. This may result in a general formation 
of abscesses and thereby cause death. 

The entire body is affected also in those diseases which are accompanied 
by fever. Fever is a disturbance of those nervous centers which regulate 
the temperature of the body, and it is generally caused by chemical poisons 
or by the poisons of germs. The generation of heat is increased during 
fever, and hence the body temperature rises and the heart beats faster. A 
certain degree of fever may be an advantage since it causes the germs to 
propagate less actively, and also because the increased vital processes form 
substances which tend to neutralize the poison of bacteria. It does not 
follow, however, that fever should not be treated. A temperature of 107 0 - 
108 F. causes changes in principles that are essential to life 5 and a fever 
of this degree must therefore be reduced as speedily as possible. 

II.—CAUSES OF DISEASE 

The following causes of disease are recognized: 

1. Mechanical Causes. Among these may be mentioned fractures of 
bones, resulting from severe blows or falls; injuries from stabbing or cutting, 
etc. This class includes also wearing apparel which wall cause deformities 
if worn for a long time. Tight shoes, for example, may cause deformities 
of toes and feet; while deformity of the thorax, and prolapse of the abdom¬ 
inal organs may result from tight lacing. 

2. Chemical Causes. These include cauterization of the esophagus 
from drinking corrosive acids; poisoning from tainted meat; lead poison¬ 
ing from the use of inferior cooking utensils; slow poisoning with mercury, 
tobacco, etc. Of great importance are also the changes which occur in 
the various organs from the continued, excessive use of alcohol. This 
affects most organs, causing shrinkage of liver and kidneys, enlargement 
of the heart, and diseases of the stomach, intestines, brain, nerves, etc. 

3. Physical Causes. Extreme heat or cold may lead to burns, frost¬ 
bite, sun-stroke, or colds. Electrical discharges may cause burns, or other 
injuries due to the passage of strong currents through the body. Sudden 
diminution of air-pressure may lead to hemorrhages. Exposure to strong 
light may cause blisters and burns. Certain phenomena of the nervous 
system occur with changes in the pressure, moisture, or electrical tension 
of the atmosphere. 

4. Deficient Food. Deficiency of lime is injurious to the bones. 
Deficiency of air and light affects the entire body (see, for example, 
Rachitis). 

5. Excess of Food. Excessive ingestion of fatty or starchy food may 
lead to obesity; of indigestible food, to relaxation of the stomach. Ab- 








82 


THE STANDARD FAMILY PHYSICIAN 


normally large amounts of fluid (beer) are responsible for hypertrophy of 
the heart. 

6. Overstrain of Organs. Every organ is injured by overstrain; but a 
single excess, followed by the necessary rest, is less harmful than a con¬ 
tinued strain which does not allow the body to recuperate. Excessive 




bicycling, for example, may cause heart-failure; while mental overstrain, 
often demanded by present social conditions, frequently leads to serious 
disorders of the brain or of the nervous system. 

7. Insufficient Activity of Organs. A certain degree of activity on the 
part of the organs is absolutely essential to health. The muscles, for in- 


Fig. 63. The anthrax-bacillus. 




Fig. 64. Streptococci. 



stance, can not remain strong unless they are constantly in use. If an 
extremity is kept immovable for a long time, as by reason of a fracture, 
the muscles of that extremity will atrophy as a consequence. 

8. Influence of Diseased upon Healthy Organs. Certain organs are so 
intimately related that a disordered condition of one reacts upon the other. 

































CAUSES OF DISEASE 


83 


Thus, contraction of the kidneys and calcification of the arteries lead to 
hypertrophy of the heart. A blood-clot obstructing an artery (see Plate 
VI. 2) may be carried to other vessels and clog also these; if the obstruction 
affects the vessels of important organs (heart, lungs, brain) sudden death 
may follow (see Veins, Inflammation of). 

9. Psychic Influence. Constant worry leads to emaciation. Violent 
fright may cause convulsions, paralysis, or even sudden death. Intense 
mental suffering may cause insanity in predisposed individuals. 

10. Heredity. It would lead too far to discuss this subject in all its 
bearings. It must suffice to say that deformities, disposition to certain 



Fig. 64 A. Gonococci (the cause of gonorrhea). 


tumors, as well as many diseases (such as gout, migraine, and mental dis¬ 
orders) are inheritable. Susceptibility to ceitain external influences, a 
condition known as idiosyncrasy, is also frequently inherited, as examples 
may be mentioned a disposition to get nettle-rash after eating crabs 01 straw¬ 
berries, and intolerance to certain drugs (as cocain, iodin, morphin, etc.). 

11. Contagion. Infection is caused by parasites which entei the body 
and propagate at its expense. Common vegetable paiasites are certain 
molds, as the Achorion Schoenlenii which settles upon the hairy scalp 
(see Favus), and the Trichophyton (Fig. 61) which is responsible for a 
common skin disease popularly known as ringworm. The body may be 
invaded also by yeast-cells, as the Oidium albicans which gives rise to thrush 
in small children. Parasitic animals well known among the laity aie the 














84 


THE STANDARD FAMILY PHYSICIAN 



Fig. 65. Spirillum of relapsing 
fever. 


itch-mite (see Scabies), the trichina (see Trichinosis), and the tape- 
worm (see Tapeworm). 

The most important organisms responsible for disease are, however, so 
small that they can be seen only if magnified 500 to 1000 times. They 
are minute, fungus-like plants; and according to custom they are called 

either microbes, or bacteria, or germs. Accord¬ 
ing to their shape they are divided into rods 
(Bacterium or Bacillus; see Figs. 62, 63), spheres 
{Coccus; see Fig. 64), and spirals {Spirillum; see 
Fig. 65). Depending upon their action upon the 
human or animal body, they may also be clas¬ 
sified into those that are harmful, or pathogenic, 
and those that are harmless, or non-pathogenic. The entire intestinal tract, 
from the mouth to the anus, harbors millions of such harmless bacteria, 
which help to break down the food so that it can be more readily acted 
upon by the digestive juices. 

The most important disease-producing bacteria are: (a) Cocci: The Coccus 
of pus, of erysipelas, of gonorrhea (see Fig. 64A), of pneumonia, and of tra¬ 
choma, etc. (b) Bacilli: The Bacillus of anthrax, of diphtheria, of typhoid, 
of tuberculosis, of influenza, of leprosy, and of the plague, (c) Spirilla: 
the Spirillum of Asiatic cholera, and that of relapsing fever. This list, how¬ 
ever, does not include all these parasites. There is a class of one-celled 
micro-organisms, belonging to the animal rather than to the vegetable king¬ 
dom, and possessing a more complicated life-history than the bacteria. They 
are called Protozoa , and some of them are unquestionably the cause of 
malaria, while others give rise to certain forms of tropical dysentery (see 
Fig. 66). Certain diseases in cattle (as Texas cattle fever) are due to mi¬ 
nute animal forms; so also is the peculiar African disease known as the 
sleeping sickness. 

Certain diseases occur only in definite localities. Thus, Malaria (which 
see) is common in the neighborhood of 
certain swampy regions, the disease bein 
transmitted through the bite of mosquitoes j 



Fig. 66 . Amebae from the intestine. 


which develop in such places, and which 
alone can inoculate the parasite from man 
to man. 

That bacterial organisms are the cause 
of disease is proved by the following gen¬ 
eral facts: (1) They may always be detected in the diseased organs of 
patients suffering from the disease in question. Fligh magnifying powers 
and special staining methods are generally necessary to identify such bac¬ 
teria under the microscope. (2) The bacteria may be cultivated from 
the diseased organs. For this purpose they are inoculated into special 







ORIGIN OF DISEASE 


80 


culture-media, upon which they will multiply if kept moist and warm. 
Such culture-media are broth, blood, or solid media (potatoes, gelatin, or 
agar-agar boiled in broth and solidified on cooling). (3) Cultures of bacteria 
may be injected into healthy animals, in which they will give rise to symp¬ 
toms similar to those observed in the original disease. (4) The original 
bacteria may again be obtained in pure culture from the infected animals. 
These laws of evidence have been termed Koch’s Laws. 


III.—ORIGIN OF DISEASE 

It is not difficult to understand how disease originates, if the disease 
process is looked upon as a reaction between the cause of the disease and 
the body. The same cause may produce symptoms of varying severity. 
Thus, insufficient food may lead to death by starvation in a short time; 
or it may affect only one constituent of the body, the red coloring matter 
of the blood, so that only a moderate degree of anemia results. Complete 
lack of sleep for several days and nights may be rapidly fatal; while a 
slight shortening of the period of sleep may result only in a moderate degree 
of neurasthenia. The same holds true for poisons. Large doses of poisons 
cause acute symptoms, and possibly death; whereas small, continued doses 

1 

give rise to altogether different symptoms of slowly developing disease. 
The same rule also applies to bacteria. Even the very same kind of bacil¬ 
lus may have different degrees of virulence in different individuals. This 
varying degree of virulence may thus determine the character of an epi¬ 
demic. In certain epidemics of scarlet fever and diphtheria, for instance, 
the affected are seriously ill and the mortality high; while in other epi¬ 
demics the disease runs a mild course and but few patients die. By special 
methods of cultivating bacteria physicians are able to increase or diminish 
their virulence, and can thus develop protective antitoxins, etc., with less 
danger to the producing animals. 

Difference in the severity of a disease may be due also to varying pre¬ 
dispositions on the part of the patients. The importance of predisposition 
has long been recognized by physicians, and has been confirmed by many 
convincing instances. The following statements can be made concerning 
predisposition: 

(1) Different organs are not equally susceptible to the same disease. 
Tubercle-bacilli, for example, if injected into the blood of an animal, will 
cause tuberculosis of the brain, lungs, and digestive organs, but never of 
the muscles; the reason for this is that lactic acid is formed in the muscles, 
and tubercle-bacilli can not multiply upon an acid medium. Trichinae mi¬ 
grate into striated muscles but never into other organs. Strychnin injected 
into an animal will affect only the cells of the central nervous system, etc. 

(2) The susceptibility of the same organ varies at different times. The 





86 


THE STANDARD FAMILY PHYSICIAN 


intestinal tract is more predisposed to cholera if a moderate catarrh is pres¬ 
ent owing to errors in diet. Cancer is more apt to develop in an ulcerated 
stomach than in a normal stomach. The susceptibility may also be varied 
by appropriate measures. 

(3) The susceptibility of the same organ or tissue differs in different 
individuals. Here inheritance plays an important role. This is especially 
marked in consumption, mental diseases, and certain nervous affections 
which occur in whole families. 

The cause of every disease must, therefore, act upon the organism; 
and the intensity of the cause must stand in a certain relation to the sus¬ 
ceptibility of the affected body. If the disease-producing factor is very 
intense, disease will almost invariably be the consequence. Sufficiently viru¬ 
lent bacteria will kill healthy laboratory animals with such mathematical 
precision that bacteriologists may estimate the actual body-weight of a dog, 
rabbit, or other animal, which will be killed by a certain culture of bacteria 
in a definite number of hours. 

The prevention of diseases caused by bacteria is better accomplished 
by avoiding transmission and by combating the bacteria themselves, than 
by altering the susceptibility of the body. Marked advance in hygiene 
(sanitary science) and in the prevention of wound-fever has thus been ren¬ 
dered possible. Surgeons will testify that vegetarians are equally as sus¬ 
ceptible to wound-infections as are those who live on meats; and hardly 
anybody would think of trying to prevent such infections by diminishing 
the susceptibility of his body. It is far more logical that the surgeon pre¬ 
vent the infecting germs from entering the wound. This may indeed be 
done in most cases, so that major operations may be attempted even on 
such organs as heart, brain, lungs, and the organs of the pelvis. The 
study of hygiene also makes it possible to destroy pathogenic germs and 
to keep them away from the body. As an example may be mentioned 
that the instillation into the eyes of the new-born of a solution of silver 
nitrate will destroy the germs of gonorrhea, if such be present, thereby 
saving thousands of children from almost certain blindness. No less im¬ 
portant is the sterilization of infective material, such as the expectoration of 
consumptives, and the stools of patients suffering from cholera, typhoid 
fever, or other contagious diseases. 

Bacteria require moisture and darkness for their propagation; they 
rarely survive when dried, or exposed to light. The sewering of cities 
dries the soil, and is therefore of great hygienic value. Small amounts of 
bacteria are best killed by heat or chemicals (disinfection of clothes, laun¬ 
dry, rooms). 

Attempts to diminish the body’s susceptibility to germ-diseases by vege¬ 
table diet, sun-baths, and porous clothing are fruitful of only slight results. 
Uncivilized tribes are exposed all day to the sun and live almost exclusivelv 











THE COURSE OF DISEASE 


87 


on plants and their valuable salts, so that they may be regarded as well 
hardened; yet their susceptibility to certain infectious diseases (such as 
smallpox, plague, cholera, and syphilis) is very pronounced. This may 
be explained as being due to the circumstance that these tribes are not 
yet saturated with these infections. It is a well-known fact that a race 
becomes less susceptible to a disease after it has passed through several 
epidemics of that disease. The reason for this is a twofold one: the more 
susceptible individuals succumb; and those that recover become immune 
from further attacks of the same disease. This immunity is thought to be 
transmitted to the offspring. One attack of smallpox will almost invariably 
render an individual immune from this disease for the rest of his life. If 
a pregnant woman suffers an attack of smallpox, the child usually passes 
through this disease and is born immune from further attacks. 

Vaccination is founded upon the observation that recovery from a cer¬ 
tain disease protects against a new infection for a considerable length of 
time. It is practised especially against smallpox, diphtheria, and hydro¬ 
phobia. Vaccination with cowpox (obtained by passing the smallpox germ 
through a cow, thus rendering it less virulent) will protect the human be¬ 
ing against smallpox for a long period. 

The treatment of diphtheria by antitoxin serum, according to Behring’s 
method, is founded on a different principle. It depends upon the fact 
that the blood of an animal (usually the horse) which has been treated 
continuously with diphtheria bacilli eventually acquires the property of kill¬ 
ing these bacteria and of neutralizing the poison formed by them. 

Injection of this serum into man protects the healthy against infection 
with diphtheria, and assists those already infected in combating the germs 
and in neutralizing the poison already formed (see Immunity). 

IV.—THE COURSE OF DISEASE 

Some diseases terminate, either successfully or fatally, in a few days; 
these are spoken of as acute diseases. Others, which run a course of sev¬ 
eral weeks, are called sub-acute ,* and still others, which icquire months, 
years, or even decades, are termed chronic diseases. A chronic disease 
may remain inactive for some time, so as to simulate a cure. This may 
frequently be observed in locomotor ataxia, epileps), consumption, gall 
stones, etc. During such periods of inactivity quacks often claim to have 
effected a cure in cases which physicians had previously pronounced incui- 
able. Reappearance of a disease which has already run its course is called 
recurrence or relapse, and is common in relapsing fevei, typhoid, ulcer of 

the stomach, varicose ulcer, cancer, etc. 

No disease invariably runs the same course in different individuals. 
The varying virulence of bacteria alone will account for mild and severe 




88 


THE STANDARD FAMILY PHYSICIAN 


cases, and for all possible intermediate forms. The regular course of a 
disease may be modified by one or more new infections. Such “mixed 
infections are not uncommon. Tuberculous lungs, for example, frequently 
harbor the germs of suppuration which are responsible for the high fever 
and the excessive cough of consumptives. Further, the susceptibility of 




io6° 
104° 
102 ° 
1 00 0 


/ * 

? 3 4 

t- S 


7 

1 

— 











Quinin 
30 gr. 


A. 

J 


/ 

/ 

N 

\l l 

\r 

f 




Fig. 67. Fever charts showing temperature-curves for (a) measles, ( b , c) malaria, and ( d ) typhoid fever. 


certain organs may considerably aggravate an infection. Scarlet fever, for 
instance, is often accompanied by suppuration of the ear and inflammation 
of the kidneys. Predisposed women may become temporarily insane after 
childbirth. 

Most of the different diseases, however, run a regular (typical) course. 
In the so-called infectious diseases, there is first a period of incubation, 
which follows directly upon the infection, and during which the patient 
feels perfectly well. This period varies in duration for the different dis¬ 
eases; it may last from three to eight weeks in hydrophobia; from ten 
to fourteen days in smallpox; from thirteen to seventeen days in chicken- 
pox; from two to seven days in diphtheria; and from four to seven days 
in scarlet fever. Then follow the stages of eruption, of the acme of the 
disease, and of improvement. The course of the fever may be so regular 
that the temperature-curve alone will enable the physician to diagnose the 
disease. 

In measles, for example, the renewed rise of temperature with the ap¬ 
pearance of the eruption on the fourth day is characteristic (see Fig. 67, a). 
The fever-curve with different types of malaria is likewise very typical. 





































































































TIIE TERMINATION OF DISEASE 


89 


The note “ Quinin 30 gr.” seen upon the charts (Fig. 67, b , c) shows that 
the reappearance of the fever on the third, fourth, and sixth days of the 
disease was prevented by giving thirty grains of quinin. The temperature- 
curve of typhoid fever shows (1) the development of the disease (gradual 
ascent of curve up to the sixth day); (2) the acme of the disease (steady 
height of curve from the sixth day to the twentieth); and (3) stage of im¬ 
provement (gradual descent of curve). The mark X in the chart (Fig. 
67, d) shows that on the ninth and thirteenth days of the disease the fever 
was temporarily depressed by quinin. 

V.—THE TERMINATION OF DISEASE 

Most diseases are self-limited, and the body returns to its former normal 
condition. In other cases bodily defects remain. These may be of no 
importance, as in the case of scars after small ulcers; or they may inter¬ 
fere considerably with the functions of organs. The scars resulting from 
severe burns may cripple the affected arm or leg completely. The new 
growths which take place on the valves of the heart after inflammation of 
the heart-membrane ( endocarditis ) may modify the openings of the valves 
and lead to grave disturbances of circulation. This may be compensated 
for by increased growth of the heart-muscle, which will intensify the motor 
power propelling the blood. Such a heart, however, can not functionate 
normally, and its owner must carefully avoid exertion. An ulcer at the 
opening between the stomach and the small intestine (the pylorus) may 
heal with a scar which will narrow the pylorus. This brings about stagna¬ 
tion of the contents of the stomach, and consequent dilatation of that 
organ. Such contraction of the pylorus can be remedied only by an 
operation. 

A number of diseases are incurable, although they may remain station¬ 
ary, without causing death. An individual may attain a ripe old age in 
spite of repeated epileptic attacks, or of permanent mental derangement, 
or of chronic catarrh of the stomach; and he may die of another disease, 
an accident, or senility. Most incurable diseases are, however, progressive; 
and sooner or later they terminate fatally. 

Death invariably sets in when circulation and respiration cease. It may 
be due to hemorrhages from the stomach or from the lungs; or to sulloca¬ 
tion in pneumonia, when obstruction of the lungs does not leave enough 
space for breathing; or it may result from destruction of the brain-centers 
which govern respiration and circulation (caused, for instance, by a blow 
on the head; or resulting from cerebral hemorrhage due to the rupture of 
a vessel). Death may follow also upon intoxication with chemical or bac¬ 
terial poisons (as in many contagious diseases), or after long-continued 
illness or insufficient nourishment. 






90 


THE STANDARD FAMILY PHYSICIAN 


A few remarks concerning cures by nature and by artificial means may 
aptly conclude this chapter. The body’s tendency toward cure depends 
upon the fact that it resists all attempts made to injure it. If a foreign 
body, such as a piece of ivory, be introduced into flesh or bone, it will even¬ 
tually be cast off by a process of suppuration. The same thing happens 
to bacteria which enter the body. They are either killed by the body, and 
removed through the perspiration, the urine, or through pus; or else they 

become encapsulated and remain 


■Mi 


& 


w § 


harmless as long as shut off from 
the rest of the body. 

The human body has the prop¬ 
erty of removing poisons through 
the natural excretory channels, or of 
rendering them harmless by manu¬ 
facturing anti-poisons. It may also 
replace losses of tissue by new 
growth, the closing of wounds by 
the formation of new skin being a 
well-known example. In fractures 
of bones, the severed ends are uni¬ 
ted by the formation of new bone 
(see Fig. 68). Wounds of the soft 
parts heal by a process of granula¬ 
tion, new tissue (so-called granula¬ 
tion-tissue) eventually filling the 
cavity of the wound; this form of 
healing leaves a shriveled scar. It 
must not be forgotten, however, 
that spontaneous healing has its 
limitations, and that not every defect can be remedied by nature alone. 
Even the contraction of scars may give rise to serious disturbances, by nar¬ 
rowing important canals of the body. In such cases the physician’s help is 
required. By cutting out the shrunken scar and sewing the raw wound- 
edges together, perfect healing will generally take place, without the forma¬ 
tion of granulation-tissue, and without contraction of the edges. The 
application of splints is necessary to make the two ends of a broken bone 
unite in a straight line (see Fig. 69). Without proper surgical treatment 
the limb may become useless. If a piece of the intestines is strangulated 
in the sac of a hernia, its walls will become gangrenous, the stools will 
discharge into the abdominal cavity, and the patient will die. By blood¬ 
less reduction, or by a surgical operation, the constriction may be relieved 
and the life of the patient saved. While the body can not form an antidote 
for every poison, it may be assisted by the direct injection of the needed 


V ; 



Fig. 68. Broken bone 
healed without short¬ 
ening. 


Fig. 69. 


Broken bone 
healed crookedly with 
shortening. 




k 













THE TERMINATION OF DISEASE 


91 


antidote. Atropin is successfully used in cases of mushroom poisoning, 
since this drug is an antidote for muscarin, the active principle of poison¬ 
ous mushrooms. 

The removal of injurious substances can not always be carried out by 
the body alone. If a collection of pus be located in the deeper parts of the 
body, the overlying tissues may be too firm to permit a spontaneous dis¬ 
charge. Unless these tissues are severed with a knife so as to permit free 
drainage, the patient may die of septic fever. A cancer-nodule is never 
cast off spontaneously; and the patient will surely die of cancer unless the 
tumor is excised at once, or destroyed with strong caustics. Without assist¬ 
ance the body can rarely deal successfully with the causes of malaria and 
of syphilis. The former may, however, be destroyed by the administra¬ 
tion of quinin, and the latter by mercury, and thus many lives may be 
saved. The principle of this treatment depends upon the fact that these 
germs are by far more susceptible to certain poisons than are the body 
cells, and that they may therefore be destroyed without injury to the sys¬ 
tem. A tapeworm may be harbored in the body for twenty or thirty years, 
but certain remedies will expel it at once. 

Great advances have been recorded also in dentistry, and no sane per¬ 
son would think of letting nature cure his carious teeth. It is therefore 
a mistake to say: “What nature can not heal, it is vain for a physician to 
attempt to cure.” Proper treatment, however, calls for a thorough knowl¬ 
edge of the properties of the human body, as well as of the peculiarities 
of the different diseases. 





DIAGNOSIS AND TREATMENT OF DISEASE 


I.—DIAGNOSIS OF DISEASE 

It is sometimes very easy to diagnose a disease, as, for instance, when 
the false membranes characteristic of diphtheria are found upon the ton¬ 
sils of a child who complains of pain on swallowing. But not all diseases 
may be so readily diagnosed. An individual may feel perfectly well, and 
yet a casual examination may reveal a disease which will soon prove fatal. 
A young man, for instance, desiring to have his life insured, submits to a 
medical examination, when it appears from the condition of his urine that 
he is suffering from diabetes. Not being convinced of the serious char¬ 
acter of his illness, he does not adhere to the diet prescribed by his physi¬ 
cian; and some day he may suffer an attack of unconsciousness from which 
he can not recover. Another young man wishes to enter the army, and is 
greatly surprised on being told that he has heart disease. He had no idea 
that anything was the matter with his heart, because his former occupa¬ 
tion, that of a tailor, never required any special exertion of that organ. If 
accepted for military service he might easily have succumbed after a fa¬ 
tiguing march. 

The state of an individual’s health can never be determined off-hand; 
a careful physical examination is always necessary to settle this question. 
If life insurance companies, railroads, military organizations, etc., were to 
have their physical examinations conducted by quacks, who claim to detect 
disease by simple methods, they would soon suffer by it. 

It has been shown in the preceding chapter that diseases cause dis¬ 
turbances in one or more organs, and that most maladies are local. An 
accurate examination of all organs is therefore necessary before an opinion 
can be given. This examination includes the physical and the chemical 
constitution, as well as the functions of the organs. The physician’s first 
care is to note the history of the patient’s illness, which may be so char¬ 
acteristic that a diagnosis can be made from it alone. In certain hered¬ 
itary diseases the family history is also of importance; and no material 
facts should, therefore, be withheld from the physician, who—in contra¬ 
distinction to the quack—is obliged by law to treat confidentially every¬ 
thing referring to his patients. 

The physical examination proceeds as follows. At first the general con¬ 
dition of the body, the body temperature, the amount of fat, and the de- 


\ 


DIAGNOSIS OF DISEASE 


99 


velopment of the muscles and bones are noted. When this is done, a more 
careful examination is made of the organs which are supposed to be the 
seat of the disease. Theii general appearance, size, form, and consistency 
are detected by inspection and feeling. With the aid of the more recent 
methods of examination the physician can inspect the interior of the eye, 
the ear as far as the drum-membrane, the nose, nasopharynx, pharynx and 



Fig. 70. X-ray picture showing piece of broken needle in hand. 

larynx, the trachea and its larger branches, and the mouth, esophagus, stom¬ 
ach, abdominal cavity (by means of laparotomy), rectum, vagina, urethra, and 
bladder. By percussion and auscultation he may get a good idea as to 
the condition of the lungs, the heart, and the other organs. On listening 
to the lungs, heart, and blood-vessels, certain sounds are heard which 
change with disease (normal and pathological heart-murmurs). Whether 
or not an organ contains air can be determined by percussion, since solid 
organs (such as lungs in pneumonia) give a different sound from those 
containing air (as normal lungs). This may be easily demonstrated by 
thumping on an empty and on a full barrel. Air-containing organs (such 
as lungs and intestines) may thus be distinguished from the solid ones 












94 


THE STANDARD FAMILY PHYSICIAN 


adjoining them (heart, liver, full bladder, tumors, etc.); and in this way 
their varying size in health and in disease may be determined. 

Chemical and microscopical examination of the various excretions (such 
as urine, gastric juice, feces, etc.) assists in diagnosing diseases. If, for 
instance, tubercle bacilli are detected in the expectorated sputum, a defi¬ 
nite diagnosis of tuberculosis can be made. Examination with the Roent¬ 
gen rays is an invaluable aid. It enables metallic foreign bodies to be 
seen, discloses injuries and changes in the bones (see Fig. 70, and Plate 
XV.), and renders it easy to observe enlargement of the heart and of the 
aorta. There are still other delicate methods of distinguishing certain 
diseases from closely related ones. If the blood of a patient supposed to 
suffer from typhoid be brought in contact with a culture of typhoid germs, 
the latter will become immovable and clump together if the patient really 
suffers from that disease. If this does not occur, the patient, as a rule, 
suffers from some other illness. 

Testing the functions of the various organs is of great importance. It 
is applied especially to the brain and spinal cord, since these two organs 
are not readily accessible to examination. The physician often tests func¬ 
tions which are hardly thought of by the layman, and which the latter may 
consider of no importance (sense of warmth, cold, touch, and pain; co¬ 
ordinated movements of the muscles; and reflex movements, such as con¬ 
traction of the pupils on illumination). The examination of the nervous 
system is so delicate that the physician can tell the exact location in the 
brain and spinal cord of tumors no larger than a cherry, and may thus 
be able to remove them by operation. 

The methods employed by quacks, on the other hand, are scant and 
often ridiculous. They frequently claim to detect a disease by inspecting 
the urine, by noting the expression of the face, or the condition of the hair, 
or even by examining wedding-rings, etc. Very often even the better 
classes get into the hands of such charlatans. It is evident that an inspec¬ 
tion of the urine will only tell whether or not the urine is clear; from the 
facial expression one can merely form an idea as to the emotional state of 
the patient; while the hair will enable a diagnosis only if it is diseased, 
which may happen once in 100,000 times. The wedding-ring will prove 
that the patient is married and, if it is worn, that she has been married 
for some time. The ring will no more disclose the patient’s disease than 
it will tell how much money she has in her pocket. It seems hardly neces¬ 
sary to mention these things; yet the claims of quacks are so loud that 
even the most intelligent are often persuaded against their will to put faith 
in them. 

Many will be greatly impressed if the physician or the quack makes 
a so-called “snap-shot diagnosis.” This, however, is not always difficult. 
By merely looking at a tall, pale individual with narrow chest, frequent 







THE TREATMENT OF DISEASE 


95 


respiration, and cough, it can easily be told off-hand that he has consump¬ 
tion, that he expectorates mucus, has difficulty in ascending stairs, rarely 
has much appetite, etc. There are many other diseases which may be 
diagnosed as readily; for instance, exophthalmic goiter, myxedema, Addi¬ 
son’s disease, advanced cirrhosis of the liver, etc. 

It is needless to say that a respectable physician will not resort to such 
methods, since he knows that much more than the actual diagnosis is neces¬ 
sary for the treatment of his patients. In addition to the name of the 
disease, its cause, character, and location must be investigated. He must 
determine how far the changes in the organs have advanced, and if the 
remaining organs are in a normal condition. The patient’s occupation, 
his means, and many other things have to be considered before a proper 
course of treatment can be decided upon. 

II.—THE TREATMENT OF DISEASE 

The treatment varies considerably with the different diseases; but in 
most cases an attempt is first made to remove the cause of the disease. 
This may sometimes be successfully accomplished. Poison accidentally 
swallowed can be washed out by means of the stomach-tube; contami¬ 
nated food can be gotten rid of by a laxative; a cancer nodule may be ex¬ 
cised; a tapeworm expelled, etc. 

If the cause of disease can not be removed, it may sometimes be de¬ 
stroyed within the body. In carbolic acid poisoning, sulphate of soda is 
given, since it combines with the carbolic acid to form a harmless com¬ 
pound. The parasite which causes scabies may be killed directly in the 
skin. Sometimes even bacteria may be killed without harming the body- 
cells. Thus, the cause of malaria succumbs to quinin; salicylic acid is 
fatal to the cause of acute articular rheumatism; and mercury destroys 
the germ of syphilis. 

Where the disease-producing bacteria can not be killed, it may still be 
possible to diminish their number or to modify their virulence. By the 
opening of an abscess many of the pus-producing bacteria are removed, 
so that suppuration will not progress any further. Bacteria present in 
wounds may be removed or rendered harmless by irrigating the wound 
with antiseptic solutions. The poison formed by diphtheria is neutralized 
within the body by injecting antitoxin. A certain quantity of injected 
antitoxin frees the body from a definite amount of poison. 

When no other remedy is at hand, an attempt is made to remove the 
poison by excreting it with the tissue-juices. To accomplish this, the ex¬ 
cretions of sweat, urine, and feces are increased. If the amount of urine 
be diminished, as in insidious Bright’s disease, some diuretic is given to 
increase this amount, since otherwise deleterious substances (such as urea) 



9(> 


THE STANDARD FAMILY PHYSICIAN 


which arc normally removed by the kidneys would be retained in the body. 
Remedies causing active perspiration and increased action of the bowels 
were formerly very much in favor, but if this mode of treatment is too fre¬ 
quently resorted to, more harm than good will be accomplished. 

To support the body in its battle with disease is another important duty 
of the physician. In many cases the body-cells alone will bring about 
a cure, and in various instances nature may be materially assisted. The 
physician thus endeavors to diminish the work of the diseased organ, as by 
advising bodily rest in heart disease, and a special diet in nephritis. The 
activity of an organ may sometimes be diminished by the administration of 
drugs; opium, for example, is given to quiet the intestines. 

In certain relaxed conditions the organs must be strengthened: weak 
muscles, by gymnastics and massage; a weak heart, by careful, active 
movements; a strained nervous system, by baths and electricity. Certain 
drugs are often very valuable in toning up some organs. Thus, a decoction 
of foxglove ( digitalis ) is more serviceable than anything else in overcoming 
stagnation of the blood due to cardiac weakness. 

The diet is a very important factor in treating disease. Thus, in typhoid 
fever, where the intestines are riddled with ulcers, solid food is actually 
dangerous; while, on the other hand, substantial food is essential to cure 
tuberculosis. Certain diseases, as diabetes, gout, obesity, etc., may be cured 
by dietary treatment alone. A “dry diet” was formerly prescribed by some 
fanatics for all ills; but at present it is considered of benefit only in the treat¬ 
ment of well-nourished patients suffering from dropsy, in order to rid the 
system of some of the accumulated fluid. 

In some cases drugs may be introduced into the system to replace sub¬ 
stances which the body can no longer form. As an example may be men¬ 
tioned the administration of pepsin and muriatic acid in diseases marked 
by deficient function of the gastric glands. In myxedema, a peculiar disease 
marked by thickening of the skin, the secretion of the thyroid gland is 
wanting. This disease can be treated successfully only by feeding the 
patient continuously with the thyroid glands of animals (see Thyroid 
Gland, Diseases of). 

It is necessary in every case to take into consideration the patient’s mental 
condition. One individual will require encouragement; another, warning. 
For one, complete rest is necessary; for another, diversion. In some 
diseases, such as melancholy and nervousness, the physician must constantly 
reassure the patient that his fears are unfounded. 

Symptomatic treatment is resorted to in diseases where the actual cause 
can not be removed. In such cases the physician directs his attention to 
the chief symptoms, endeavoring, for example, to reduce fever by baths 
and drugs, or to deplete blood in internal inflammations, by mustard-paper, 
leeches, or cupping. In incurable cases, the physician may only be able to 








THE TREATMENT OF DISEASE 


97 



order proper nourishment and to diminish the patient’s suffering. The 
last days of life should be made as comfortable as possible, so that death 
may be painless. This can be accomplished only by the aid of drugs. 
The symptomatic treatment has been unjustly ridiculed by those who claim 
to cure by “Nature.” In incurable diseases the laws of humanity demand 
a relief from distressing symptoms; while in curable affections this form of 
treatment is often indirectly curative. Attacks of biliary colic run a much 
milder course, and gall-stones pass through the ducts more readily, if proper 
anodynes are given. 

The water-cure itself constitutes a purely symptomatic form of treat¬ 
ment, tending only to increase or diminish the excretions or the circulation 
in some part of the body, to raise or lower the body temperature, or to 
stimulate or quiet the nerves. It is evident that this may be very good for 
some patients, but it constitutes only a very small part of the remedies at 
the disposal of the physician. Only a quack can laud a remedy as useful 
for a great many ailments; but he who claims to be able to cure all diseases 
is a still greater fraud. It is no more possible to do this than to construct 
a key that will fit all locks. It is often impossible to diagnose with cer¬ 
tainty a beginning cancerous node in the lungs, or to remove it by operation 
or otherwise. And it is likewise impossible to restore a perforated heart- 
valve to its normal condition. 

The proper treatment of patients calls for a great deal of knowledge and 
tact on the part of the physician. He must have a thorough knowledge of 
the various diseases and remedies, and must also take the patient’s means 
into consideration. The treatment of disease is an art which can not be 
acquired without diligent study, and even then it is not everybody who can 
practise it well. A great variety of remedies may be applied in combating 
a disease. Thus, for anemia the physician may prescribe light-baths, 
drugs, or change of climate; or he may clean out the bowels, since their 
fermenting contents deteriorate the blood. Not every patient with the same 
ailment will tolerate the same remedy equally well. The physician’s ex¬ 
perience and instinct must choose what is best. The layman should never 
suggest a certain line of treatment, particularly since the same symptoms 
may signify a variety of different diseases. Oppression in the stomach, and 
belching of gas after eating may be signs of nervousness, of catarrh of the 
stomach, or of an ulcer or cancer of the stomach. In the last-named case, 
an immediate operation is necessary; in the first-mentioned, a simple remedy 
like bicarbonate of soda may remove all the symptoms. In such cases 
advice by one who is not a physician may delay the proper treatment. 


L.0FC. 














THE STANDARD 
FAMILY PHYSICIAN 


A—L 


X 












THE STANDARD FAMILY PHYSICIAN 


A 

ABDOMEN. —See Introductory Chapters. 

ABDOMINAL PAINS. —Pains which originate in the stomach, intestine, 
peritoneum, in the liver, spleen, uterus, or in the kidneys and in the genital 
organs situated in the abdominal cavity. They may occur either tempo¬ 
rarily, in attacks (see Colic), or they may exist more or less permanently. 
They are caused by quite varying affections of the above-named organs: 
Inflammations, suppurations, adhesions, ulcers, tumors, etc. The pains are 
sometimes restricted to only one or several places, at other times they extend 
over the entire abdomen. The direction in which the pains may radiate is 
of importance in recognizing the causative disease, or in determining its sig¬ 
nificance. The intensity of abdominal pains, even in one and the same dis¬ 
ease and in the same patient, is subject to great variations. At times such 
pains are very slight, while at other times, as a result of impacted gall-stones 
or kidney stones, they may be so severe as to cause even robust men to faint. 
The pains are brought about by marked irritation of the nerves of the 
affected organs. 

The best remedy for abdominal pains of any kind are hot compresses 
(moist or dry) which must be renewed as soon as they become lukewarm. 
Most suitable are linseed poultices and hot plates, or hot-water bags. A 
hot-water enema may relieve many a severe attack of colic, particularly if 
there has been a persistent constipation. The physician is also able to com¬ 
bat very intense pains effectually by medicines which are given internally 
or injected under the skin. Every patient with severe abdominal pains who 
is not relieved easily by hot applications or hot enemas needs professional 
advice. 

ABORTION.— The expulsion from the uterus of the fetus before it is 
viable. Abortion may be brought about accidentally or wilfully. The wilful 
act, no matter at what time of pregnancy it is perpetrated, is severely pun¬ 
ished by the laws of most civilized countries. In the German statutes, for 
instance, a pregnant woman who purposely induces abortion or kills the 
fetus in the uterus, is liable to imprisonment for a period not exceeding five 
years. The same punishment applies to those who provide her with the 
means of doing this or in any way assist her in the act. Similar laws are on 



Absinthism 
Addison’s Disease 


THE STANDARD FAMILY PHYSICIAN 


102 


the statute books in the United States, where the causing of an abortion is 
a misdemeanor; if death of the mother results the crime is murder. The 
means referred to include certain internal medicaments and instrumental 
procedures—intra-uterine injections intended to rupture the membranes 
or separate the embryo from its attachments. Mechanical means are cer¬ 
tain to bring on labor pains and the expulsion of the ovum; but the action 
of the popular, internal remedies is very uncertain and often harmful. 
Their use may lead to severe and sometimes fatal poisoning or to perma¬ 
nent injury to health. The mechanical methods without proper precau¬ 
tions in regard to absolute antisepsis may cause general blood-poisoning and, 
if the instruments are unskilfully used, a rupture of the uterus. Both of 
these may lead to a fatal issue. Persons who sell drugs or instruments, 
knowing the purposes to which they will be put, are guilty of misdemeanor. 

Severe illness of various kinds in pregnancy may require the induction 
of abortion in order that the woman’s life be saved. The physician should, 
however, exercise this right only after due consultation w T ith a colleague. 
Many abortions, called also miscarriages, are due to accidental causes. 

ABSINTHISM. —A chronic form of alcoholism to which is superadded 
the effects of the volatile oil of absinth (Artemisia absinthium) and other 
volatile oils, particularly oil of anise, which is the predominant flavor of the 
drink. The effect on the brain of many of the volatile oils, particularly that 
of absinth, is to cause mental excitement; and when used in conjunction 
with alcoholic drinks a form of maniacal excitation may be brought about 
in some. Convulsive seizures of an epileptiform nature are also known to 
occur in chronic absinth drinkers. 

ABSCESS. —A local collection of pus, consisting of broken-down blood- 
cells, some disintegrated tissue, and bacteria. An abscess is usually local¬ 
ized, or kept within narrow bounds by the, effort of nature to wall off other 
parts of the body from infection. Abscesses in the skin, usually due to an 
Infection which travels down in a hair follicle, or a sweat gland, are termed 
Boils or Carbuncles. Abscesses in the fingers, usually pointing beneath 
the nails, are termed felons. Abscesses are frequently found in the liver, 
from amebic infection, or typhoid fever; and also in the abdomen as a 
result of an inflamed or gangrenous appendix (see Appendicitis; Peritoni¬ 
tis). They are frequently found in bones and are here often called cold 
abscesses, because they are chronic in their course. Such cold abscesses are 
usually due to the bacillus of tuberculosis. Abscesses of the brain frequently 
result from infection through a running ear, or an infected mastoid, occa¬ 
sionally after an accident. 

Abscesses may break into the open air (as in boils, felons, etc.), in which 
case they frequently heal spontaneously; or they may break within the body 
and are then dangerous, causing septicemia or pyemia. See Boil; Car¬ 
buncle; Pyemia and Septicemia. 





103 THE STANDARD FAMILY PHYSICIAN £$®* nth * s “:. 

^ Addison’s Disease 


ACNE.— A disease of the fat-follicles of the skin and often of the adjacent 
hair-follicles. Simple acne, or pimple, “indurated acne,” a more deep- 
seated affection, “rose acne,” and “rum blossoms” are types of this disease. 
See Skin, Care of. 

ACONITE (Lat. Aconitum ).—A genus of plants belonging to the Butter¬ 
cup family ( Ranunculacecc ) which are highly poisonous and have been used 
in medicine for many centuries. Aconitum napellus is the plant that yields 
the commonly used medicine. The action of aconite is due to an alkaloid 
(i aconitin ) which is one of the most powerful poisons known. Aconite causes 
the heart to beat more slowly from depression of the heart muscle and from 
stimulation of the inhibitory apparatus. It also dilates the blood-vessels, 
causes sweating, and diminishes the sensibility of the nerves of touch and pain. 
In poisonous doses (more than 5 drops of the tincture may cause poisoning) 
the symptoms are nausea, vomiting, cold and clammy skin, great prostra¬ 
tion, and slow irregular pulse. Artificial respiration, hot coffee, and hot 
bottles are useful until a physician arrives. Aconite is a very powerful 
drug, and should be prescribed by none but physicians. 

ACTINOMYCOSIS. —A disease caused by a ray-like mold (Actinomyces 
bovis) which grows upon ears of corn, and grains. It occurs oftener in ani¬ 
mals, particularly cows, rarely in men. The mold finds access to the human 
body through injuries or wounds of the mucous membranes of the mouth 
or pharynx, or through carious teeth, or by way of the gastro-intestinal tract. 
The disease develops generally in the jaw-bone, which swells and becomes 
partially destroyed; also in the cheeks, the tongue, the throat and the neck, 
spreading to the vertebral column and to the thorax. Firm swellings appear 
which soften, break through, and discharge thin pus, containing yellow-col¬ 
ored particles in which the fungus characteristic of the disease may be 
detected by the microscope. The course of the disease is either short, 
accompanied by fever, or it may last for months and years, and lead to 
degeneration of the organs and to death. Certain forms resemble chronic 
pulmonary tuberculosis. Milder cases may be cured if taken in time. Both 
mild and severe cases are sometimes cured by operative interference. For 
the prevention of this condition, some stress may be laid on the senseless 
habit of chewing grass. 

ADDER-BITE. —See Snake-Bite. 

ADDISON’S DISEASE. —A morbid condition associated with inflamma¬ 
tion or tumor of the suprarenal bodies, thus disturbing their function, and 
characterized by the appearance of a mottled or uniformly distributed 
brownish discoloration of the skin, especially in those parts of the body 
which are exposed to the light (see Plate XIV., Fig. 3). The staining may 
extend into the mucous membrane of the mouth, and may also be present 
on the soles of the feet, around the waist in women, and in other localities 
where the skin is normally somewhat darker than usual. During its early 





Dolorosa THE STANDARD FAMILY PHYSICIAN 104 


stage the disease is marked also by fatigue, weakness, loss of appetite, vom¬ 
iting, and diarrhea or constipation. Later on there are observed additional 
symptoms, as headache, insomnia, mental weakness, emaciation, and peri¬ 
ods of unconsciousness. The disease usually persists for many years. The 
treatment consists of measures directed to the strengthening of the system 
and the alleviation of distressing symptoms as they appear. The adminis¬ 
tration of suprarenal extract in tablet form has been attended by good 
results. Cathartics must be given with caution, as in certain cases they may 
make the disease worse. 

ADIPOSIS DOLOROSA. —A disease, chiefly of women, attended with 
marked obesity and neuralgic-like pains, usually localized over fatty swell¬ 
ings in the body. It has been at times associated with alteration in the thy¬ 
roid gland, and internal administration of the thyroid secretion has proved 
of service in some instances. 

ADOLESCENCE. — See Growth. 

AGARICUS. —The name of a large group of fungi generally character¬ 
ized by an umbrella-like hood and radiating gills beneath. At one time the 
name Agaricus covered the whole group, but it is now split up into a number 
of genera, or subgenera, differentiated largely by the color of the spores 
and the shape and attachment of the gills. The ordinary edible mush¬ 
room of the fields is the Agaricus (Psalliota) campestris; the poison 
cup, Agaricus ( Amanita ) phalloides; and the fly mushroom, Agaricus 
(Amanita) muscaria. At least a thousand different species are known, 
many of them being edible and a few poisonous. See Plate XX.; also arti¬ 
cle Mushrooms. 

AGGLUTINATION.— See Widal Test. 

AGGLUTININS.— See Immunity. 

AGORAPHOBIA. — See Fear; Obsessions. 

AGUE. — See Malaria. 

AIR-BATH. —A bath in which the patient exposes his bared body to the 
(agitated) air, at the same time taking vigorous exercise. Every sun-bath is, 
naturally, also an air-bath; but in the true acceptation of the word, the 
above-mentioned form of bath is that generally implied by the term “air- 
bath.” For the purpose of administering these air-baths, modern sanatoria 
are often supplied with these so-called air-bath parks. But, unfortunately, 
even procedures which are hygienically of value are often exaggerated. 
Careful persons begin with air-baths in the room, with the windows open, 
taking at the same time gymnastic exercises. Exercise is absolutely neces¬ 
sary, to stimulate the circulation of the blood; if this is not done, the bather 
exposes himself. To begin the treatment, a warm, sunny day should be 
selected. After being gradually accustomed to air-baths, they may be 
taken at lower and lower temperatures, the length of time of exposure 
depending in large measure on the condition of the air. 








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PLATE III. —THE CHEST AND ABDOMEN 
(After removal of skin and muscles) 


1. Right subclavian artery 

2. Right subclavian vein 

3. Right lung 

4. Diaphragm ( covered by pleura) 

5. Space between right and left pleura 

6. Right lobe of liver 

7. Gall-bladder 

8. Ascending colon 

9. Bladder 


10. Left subclavian artery 

11. Left subclavian vein 

12. Left lung 

13. Heart (covered by pleura) 

14. Left lobe of liver 

15. Stomach 

16. Transverse colon 

17. Descending colon 

18. Small intestines (jejunum and ileum) 



Plate III 
















1° 5 THE STANDARD FAMILY PHYSICIAN Adiposis Dolorosa 

_____ Albinism 

Air-baths stimulate the skin, produce an agreeable feeling of warmth, 
and refresh the body and nervous system. They are an excellent measure 
•for arousing hypochondriacal persons to greater self-confidence. Air-baths 
have had more vogue in Germany than in the United States; indeed, there 
seems to be little need for them in the latter country in view of the excellent 
outdoor bathing facilities enjoyed 
by nearly all. 

ALBINISM. —An abnormal de¬ 
ficiency of pigment or coloring 
matter, “albinos” being the term 
applied to persons thus afflicted. 

The symptom is a lack of the pig¬ 
ment normally present in the skin, 
the hair, and in certain membranes 
of the eye. As a result the pupil 
and the iris are reddish, and the 
skin of the body a pale white, only 
in places presenting a pink tint due 
to the underlying blood-vessels; the 
hair is a yellowish white, thin, and 
resembles flax (see Fig. 71). Apart 
from certain visual disturbances (ex¬ 
treme sensitiveness to light, etc.), no other symptoms of any consequence 
have been observed. The condition is congenital, and continues unchanged 
through life. There is no known cause for the trouble. Heredity is not 
apparently a factor. Among the white races, albinism is more infrequent 
than among the negroes. It has been thought that the condition may result 
from an arrested development of the pigmentary layer in the embryo. 

Aside from a condition of general lack of pigment, there are cases marked 
by localized absence of coloring matter, which may be manifested at birth, 
or developed later in life. In these the skin may show white patches of 
varying size and shape, and whatever hair grows on them is also of a whitish 
color. Where this condition comes on later in life, the white patches are 
surrounded by a more deeply pigmented area. The spots may enlarge and 
run together to such an extent that the skin closely resembles that of an 
albino. There are no disease symptoms connected with this complaint. 
White patches of varying sizes may also appear in persons afflicted with 
syphilis or leprosy. Albinism of the eye refers to the congenital absence 
of pigment in the iris and choroid coat. As the former is transparent, it 
appears pink owing to the underlying blood-vessels. A red shimmer which 
is also seen in the pupil is due in part to the vessels in the choroid, and also 
to the light which can penetrate through the sclerotic coat in these eyes. 
These conditions are distinctly shown in white rabbits. Albinism is always 



Fig. 71 Albino. 













Albuminuria 

Alcoholism 


THE STANDARD FAMILY PHYSICIAN 


106 


accompanied by disturbances of vision; the afflicted persons being more or 
less nearsighted, and it will be observed that the eyeball is constantly in 
motion. Vision is poor in sunlight owing to the glare, but improves at night. 

ALBUMINURIA. —A condition marked by the presence of albumin in 
the urine. Albumin may be excreted by the kidneys in the urine either in a 
dissolved or an undissolved form. That dissolved in the urine is not visible 
and can only be demonstrated by chemical tests; the other is present in the 
form of various coagulated products, which may be recognized by the aid 
of the microscope, as casts of the renal tubules, cellular constituents of these 
organs, etc. Albumin in the urine may be present in various percentages in 
diseases of the kidneys, severe constitutional disturbances, poisoning, acute 
febrile diseases, affections of the heart, lungs, and blood, and even in healthy 
persons after bodily exertion, forced marches, or very cold baths. Albumi¬ 
nuria must, therefore, be looked upon as a symptom of varying import, 
which in many cases may be without any significance. It only becomes of 
moment when it is a permanent condition or is combined with the throwing 
off of kidney cells or of casts of the renal tubules. See Kidney, Diseases of. 

ALCOHOL or SPIRITS OF WINE (called also ETHYL ALCOHOL, to 
distinguish it from other varieties of alcohol). —A colorless, inflammable 
fluid with a burning taste and manifesting great resistance to cold. Tem¬ 
peratures which render mercury solid do not freeze alcohol. It is produced 
by fermentation from sugar solutions, the sugar being converted into alco¬ 
hol and carbonic acid. It is also commonly made from potatoes and grain, 
such as barley, rye, corn, and rice. These plants contain starch which, 
under the influence of certain fermentative processes known as malting or 
mashing, is split up into sugar and other substances. The addition of water 
induces fermentation which results in the production of alcohol such as that 
contained in beer or whisky. In the latter the percentage of alcohol is 
increased by the process of distillation. 

There are various strengths of alcoholic fluids. Absolute alcohol is en¬ 
tirely free from water, and the ordinary cologne spirits is 90 per cent., or 
even 95-96 per cent, alcohol. Next in strength comes rum, which is largely 
made from sugar-cane, and which may contain as high as 70 per cent, of 
alcohol; arak, made from rice or palm wine, with 50 per cent.; and French 
cognac, distilled from wine, which contains almost as much. The ordinary 
whiskies contain from 40 to 50 per cent, alcohol, while the German whisky, 
“branntwein,” varies between 30 and 40 per cent. In the cheapest as well 
as in the most expensive whiskies, there are present, in addition, certain 
amounts of amyl, propyl, and other alcohols, known collectively by the name 
of fusel oil, which are highly poisonous. Wines and beers, which are not sub¬ 
jected to distillation, contain much smaller amounts of alcohol: Bohemian 
beer, 3-4 per cent.; Munich beer, 3-8 per cent.; porter, 5-10 per cent.; 
white wine, 5-12 per cent.; French red wine, 9-14 per cent.; southern wines, 




107 


THE STANDARD FAMILY PHYSICIAN 


Albuiiilnuria 

Alcoholism 


IO ” I 7 P^ r cent., champagne, 9 20 per cent. A natural wine (as sherry) 
should not contain more than 17 per cent, of alcohol. If more than this is 
found, it has been added secondarily. The ordinary cordials contain about 
40-50 per cent, alcohol in syrup and volatile oils. 

ALCOHOLISM. —Alcoholic beverages have been consumed from time 
immemorial. Tacitus reports their being used by our forefathers, the old 
Germanic tribes; and the immoderation of the middle ages, especially in 
drinking, is well known. At all times, man has sought and made use of 
substances which produced a narcotic effect, and by means of which sorrow 
and pain could be forgotten for even brief periods. Some peoples have 
obtained the desired result by means of alcohol, others by the use of other 
narcotics, notably opium by the orientals, hashish by the natives of India, 
Egypt, etc. Some people drink wine, beer, or whisky to give them the sense 
of strength and power; others to give them the feeling of warmth; and still 
others claim that without alcohol there can be neither happiness nor socia¬ 
bility. All the claims seem plausible enough, but as an actual fact it may 
be stated that the apparently favorable effects of alcoholic indulgence are 
based on self-deception. 

The ingestion of any alcoholic beverage is usually followed by a sensa¬ 
tion of warmth. The face becomes flushed, speech flows readily, and there 
is developed a desire for action. Persons who are ordinarily quiet become 
loquacious, sometimes happy, sometimes quarrelsome. These results are 
attributed to the stimulating effects of the alcohol, but in reality the condi¬ 
tion is quite complex and rarely a true stimulation. The blood-vessels in the 
skin dilate, because the nerves controlling their movements are partly para¬ 
lyzed. The blood therefore rushes to the surface and imparts a sensation 
of warmth. This spreading of blood on the surface, however, rapidly chills 
the body; and as a matter of fact the interior of the body becomes colder 
rather than warmer. For this as well as for other reasons, an intoxicated 
man is more likely to be frozen than one who is sober. The readiness of 
speech and flight of ideas also depend on the loss of restraint put on certain 
mental faculties. The bonds which counsel quiet, moderation, and good 
sense, are loosened, and the man deep in wine talks on, careless of the con¬ 
sequences which his ready speech may bring to himself or to others. In this 
respect there can be no doubt of the correctness of those well-known words 
“in vino veritas” (in wine there is truth), but the truth is not the expression 
of a free will, but merely the prattle of an irresponsible agent, an uncon¬ 
trolled reflex machine. The great quantity of words spoken lowers their 
worth, and they are spoken without restraint. Such a person can not follow 
a discussion nor put together the impressions received. He indulges in un¬ 
necessary and numerous gesticulations, often destroys the property of others, 
and desires to show his power by fighting. It is a mistake to attribute the 
latter result to any stimulating action of the alcohol; on the contrary, it is 






Alcoholism 


THE STANDARD FAMILY PHYSICIAN 


108 


an evidence of loss of power to control, rather than any heightening of pres¬ 
ent faculties. In other cases, a benumbing of the sense of fatigue occurs, 
but the person apparently refreshed is later all the more exhausted. 

If the indulgence in alcohol is continued, these paralytic conditions be¬ 
come more and more marked. The flushed face becomes pale, the eyes 
lusterless, the loquaciousness diminishes, the speech is indistinct, the general 
activity subsides. Unconsciousness more or less marked, accompanied by 
a cold, clammy condition of the skin and slow noisy breathing, follows, and 
the intoxicated individual recovers from his exuberance of spirits and deeds 
in a resting-place often involuntarily selected. Not uncommonly, twitching 
and convulsions may result from alcoholic indulgence, and in some persons 
the narcotic state may come on without any preliminary period of excite¬ 
ment. Sudden death may ensue, and this has been observed where persons 
have taken large amounts of alcohol within a short time, as on a wager. 

Repeated intoxication, or even the long-continued, apparently moder¬ 
ate indulgence in alcohol which in time exceeds certain limits, can gradu¬ 
ally bring about an insidious poisoning of the system, which may be desig¬ 
nated as chronic alcoholism. The stomach, being constantly exposed to the 
irritating effects of the alcohol, is the first organ to suffer and it soon becomes 
the seat of a chronic catarrh. As a result of this the appetite diminishes, 
nutrition is interfered with, and the entire system is thereby weakened. Morn¬ 
ing vomiting is very common, the vomited material consisting largely of 
saliva swallowed during sleep, and of the excess of the mucus due to the 
catarrhal process. The liver becomes the seat of a slow degeneration; it 
becomes fatty, or more often new connective-tissue growth causes it to con¬ 
tract; the kidneys do not functionate as well, and also become cirrhotic; 
the heart enlarges, particularly in beer drinkers, on account of the increased 
amount of fluid which it is compelled to propel through the body; it under¬ 
goes fatty degeneration, and gets gradually weaker. Men who drink a great 
deal without any apparent ill effects, often die very suddenly from cardiac 
weakness. In addition to the symptoms just enumerated, there are also de¬ 
veloped various chronic catarrhs of the throat, larynx, and intestine; and the 
arteries undergo hardening which may go on to chalky hardening, or calcifica¬ 
tion. Of great moment is the involvement of the blood-vessels of the brain 
and nervous system. An ordinary trembling of the hands is a common symp¬ 
tom of over-indulgence. There may be sensory disturbances, such as pains 
in the arms or legs. These may gradually lead to inflammation of the nerves 
(neuritis), with loss of power to raise the wrist, or raise the toes; or the brain 
itself may give out, and epilepsy and insanity develop. 

In short, there is scarcely an organ of the body which is not influenced by 
alcohol sooner or later, and to some extent permanently damaged. In time 
the higher mental faculties become affected, and the individual becomes 
dull, awkward, careless, and thick-witted. Character and self-control are 



109 


Alcoholism 


THE STANDARD FAMILY PHYSICIAN 


lost, and the longer the habit has been present, the more difficult it becomes 
to overcome it. The drunkard’s sense of his obligations to hia family, to 
decency, and to custom, disappear, and soon he does not even realize the 
disgrace of his condition, having become wrecked both in mind and body. 
As the habit gradually diminishes the resisting powers of the organism, the 
alcoholic readily succumbs to diseases which the ordinary person with¬ 
stands. 

Delirium Tremens is a special type of acute poisoning which frequently 
develops during the course of chronic alcoholism. It is apt to come on after 
a particularly prolonged debauch and is frequently set off, as it were, by a 
severe general disease, such as pneumonia, by injuries, or by great mental 
excitement. The patients are at first very nervous; they are in constant 
motion, tremble, have no appetite, can not eat, or keep anything but liquids 
in the stomach, and they sleep very badly. During the day they may keep 
control, but as night comes on they frequently have hallucinations of sight 
and of hearing, these sights often being worse than the most dreadful of 
nightmares. In the severe cases the patients become wildly insane, mani¬ 
acal; they may commit murder if unrestrained. Under proper treatment 
they frequently recover, but often die of extreme exhaustion. 

A great deal can be said concerning the close relation of alcoholism to 
crime, but it will be sufficient to call attention here to the fact that a large 
percentage of the cases of murder, assault, resistance to the law, bur¬ 
glary, etc., can be attributed to the effects of this habit. Suicide, primarily 
or secondarily, may often be traced to alcoholic indulgence. Venereal dis¬ 
eases are frequently contracted by men during a debauch and transmitted 
to their wives. How much more dangerous than the ordinary deadly poi¬ 
sons, is, therefore, this substance, which not only affects the one who im¬ 
bibes it, but also numerous innocent persons, destroys families, and even 
manifests its evil influence in succeeding generations. Sympathy must be 
extended to those unfortunates who are weak-minded or insane because 
their fathers were drunkards, and to those who are predisposed to nervous 
or mental diseases, to which they sooner or later must succumb. Disease, 
asylums, prisons, early death, and suicide can all be laid at the door of this 
enemy of mankind, which, in the guise of banishing pain, has falsely been 
called one of the benefactors of the human race. It would be possible to 
abandon many prisons and asylums if the continual poisoning of the na¬ 
tions by alcohol could be stopped. 

The so-called periodic drinkers (dipsomaniacs) constitute a group by 
themselves. Sleeplessness, restlessness, headaches, etc., are the preliminary 
symptoms which stimulate a craving for alcoholic beverages, which they 
can not resist and which must be satisfied at any cost. They care less for 
the kind or quality, than they do for the quantity consumed. As soon as the 
attack is over, little or nothing is taken, until the craving again comes on, 








Alcoholism 


THE STANDARD FAMILY PHYSICIAN 


110 


which may be after an interval of weeks or months. Periodic alcoholic 
indulgence of this kind is usually a part of a periodically appearing mental 
disturbance, periodic mania or melancholia, or sometimes of acute exacer¬ 
bations of nervous diseases, in which the patient employs the alcohol as a 
narcotic medium. Repeated or long-continued attacks may be followed by 
delirium, and occasionally they may end fatally. 

The consumption of alcoholic beverages is steadily increasing, in spite of 
the undoubted harmful influences which they exert. The gigantic establish¬ 
ments for their production are the developments of the last few decades, and 
their growth depended on this fact. The consumption of beer particularly 
has markedly increased in all countries. Statistics are unnecessary here. They 
show, however, that the consumption of whisky has diminished during 
late years, whereas that of beer has largely increased. Many look upon this 
as a favorable sign, because whisky, being considered a stronger drink, is 
believed to be more unhealthy than the lighter beer. It must not be for¬ 
gotten, however, that beer is consumed in much larger amounts than whis¬ 
ky, so that in the end the same quantities of alcohol are taken. As a whole, 
it is immaterial whether one favors beer or whisky. Whisky drinkers are 
more apt to develop delirium tremens and gastric and hepatic troubles than 
are beer drinkers, but the latter, aside from the effects due to the alcohol 
itself, endanger their heart and kidneys. The heart is affected by the in¬ 
creased quantity of fluid which it must pump, and the kidneys by the larger 
amounts of fluid which they are compelled to filter. It is impossible, there¬ 
fore, to group alcoholic beverages on the score of their comparative harm¬ 
lessness; all of them act as poisons to the human organism, and are harmful. 

In passing, attention should also be directed to the chronic intoxications 
due to the consumption of ether, cologne, and absinth. Ether drinking, 
which is particularly prevalent in Ireland, brings on a condition of transi¬ 
tory intoxication without any after-effects. Many subject themselves to this 
intoxication several times daily; and long-continued adherence to the habit 
affects both body and mind in a manner similar to that associated with 
chronic alcoholism. The use of cologne is attended by like effects, and the 
habit is particularly prevalent in Russia, England, and America. Chronic 
absinth poisoning differs slightly from that caused by alcohol, the effects 
being due to the contained ethereal oils. The consumption of absinth is 
limited almost entirely to France, and its continued use leads to severe ner¬ 
vous disturbances, extreme sensitiveness of the skin, pains, epileptic con¬ 
vulsions, and finally, in many, to insanity. 

Until very recently, the drinking habit was looked upon as an incurable 
evil. Efforts were confined to exhortations which usually went unheeded. 
A great advance was made when it came to be realized that complete absti¬ 
nence could alone free the individual from his desire for alcoholic bever¬ 
ages. The damage done to the various organs can not be rectified, but 





Ill 


THE STANDARD FAMILY PHYSICIAN 


Alcoholism 


the drinker can be warned of further inroads on his health which are liable 
to occur. He again becomes the support of his family and a useful member 
of society. There is no medicine or secret remedy which, taken alone or 
with the alcoholic beverage, will cure the disease, and such claims are 
fraudulent. 

The elementary principles for correcting the habit are about as follows. 
The individual must practise complete and total abstinence. In order to 
accomplish this, it is wise to commit him to a sanitarium specially devised 
for this purpose. When he is returned to his family, the latter must also 
lead an abstemious life. A change of occupation is advisable, especially 
if the person has been engaged in one which would lead or tempt him 
to indulgence. Furthermore, it is essential for him to associate with 
people who are also abstainers, and he should be encouraged to become 
a member of an organization which has for its main object the redemp¬ 
tion of drinkers. 

These societies, a number of which are known in America, can be divided 
into those which counsel total abstinence, and those which permit moderate 
indulgence; there are, besides, other organizations which combine both of 
these principles. This brings about a paradoxical situation in the practical 
treatment of the alcohol question; whether the evil had better be combated 
by abstinence or by temperance. Our views are as follows: Any person who 
is made sick by alcohol, or is in any way harmed, must undoubtedly practise 
total abstinence. This also applies to any one who can not resist the tempta¬ 
tion to drink more than is good for him, or who numbers among near or dis¬ 
tant relatives any who are subjects of this habit. The danger lies in the 
fact that a slumbering predisposition to alcoholic overindulgence may be 
present, which under appropriate circumstances may be stimulated to its 
full development. Every drinker claims to have been moderate at some 
time in the past! An abstemious life should also be led by any one who 
wishes to make his life an example for those about him. It is only by com¬ 
plete denial that the tide may be stemmed. The example of moderate in¬ 
dulgence is of less value for the cause, because the conception of moderation 
may be interpreted to suit the individual caprice. He who believes that he 
can not get along without alcoholic beverages should limit himself to small 
quantities, and then not fail to admit that he takes them, not for any bene¬ 
ficial properties supposed to be present in the alcohol, but merely to satisfy 
a taste as distinguished from a craving. But he must beware of drinking 
daily as a matter of custom, remembering that amounts which are ordinarily 
considered harmless have been shown by physicians to create a great deal 
of damage when taken day after day. This even applies to three or four 
glasses of beer per day. Many who believe themselves moderate can not, as 
a matter of fact, be included under this designation. 

If we finally try to persuade ourselves that alcohol is a necessary aid to 





Alcoholism 

Alkaloids 


THE STANDARD FAMILY PHYSICIAN 


112 


the encouragement of happiness and sociability, it will be found that the 
experiences of the total abstainers prove the contrary. Mankind would be 
in a sad state if pleasure and enjoyment could not be generated without the 
excitation secured by the use of alcohol. It would require too much space 
to discuss in detail all the measures which have been proposed for the pur¬ 
pose of combating and preventing this habit. Legal restriction can not be 
formulated until the public becomes converted to a different view regarding 
the value of alcohol. The necessary understanding and support of laws 
directed against alcoholism can not be secured until this has been accom¬ 
plished. Preparatory to this it is now possible, however, to institute certain 
reform measures which will tend to bring about the ideal. Among them 
may be mentioned stricter requirements in granting licences to saloons, 
forbidding the sale of intoxicants before working hours, favoring saloons 
which do not dispense alcoholic beverages, and the erection of a better 
class of dwellings for the working people. A great service can, moreover, 
be rendered by everyone who undertakes to break down the old mistaken 
notion that alcohol is gifted with wonder-working powers. As has been set 
forth, alcohol does not increase the strength or stimulate the body-heat; nor 
does it favor digestion. It is a well-known fact that in training for athletic 
feats, the use of alcohol is strictly prohibited. North Pole explorers, and 
those engaged in whale fisheries, deny themselves any indulgence in alcohol. 
Abstinence is also required of those who reside in the tropics. In the cases 
of so-called frenzy of the tropics, overindulgence in alcohol probably plays 
an important role. 

In recommending alcohol as a nutrient or stimulating agent, it should 
not be forgotten that there is an abundance of such agents which are not 
harmful. Alcoholic beverages have only a limited application in medical 
treatment, and in most cases they can well be omitted. The custom of 
bringing along a bottle of strength-giving port, or some medicinal wine, 
when visiting the sick, should be given up and the patient regaled by other 
friendly attentions, such as flowers, fruits, etc. Especially harmful is the 
giving of wine to children. Up to the twentieth year, wine and beer should 
be strictly prohibited. 

If by these means the taste for alcoholic beverages is overcome or at 
least diminished, the question naturally arises, “what shall be substituted 
for them?” It is a well-known fact that an abstemious individual gradually 
loses the desire to drink, finally ingesting only an ordinary amount of fluid, 
sufficient to satisfy his natural thirst. Drinking does not come from in¬ 
creased thirst, but, on the contrary, the thirst may be said to be due to the 
drinking. In order to furnish the opponents of alcohol a variety in their 
beverages, a number of substitutes free from alcohol have been placed on 
the market, including non-alcoholic wine and beer, unfermented apple- and 
grape-juice, and a host of others. The abstainers are satisfied, but the 





113 


THE STANDARD FAMILY PHYSICIAN 


Alcoholism 

Alkaloids 


drinkers do not find them to their taste, because the alcohol has been 
omitted. 

At present there is no efficient substitute, and the evil can not be checked 
by this means. Education and the force of example are now the only agen¬ 
cies by which any favorable results can be attained. One should not bow 
down to the almost universal social custom, which prescribes the use of 
alcohol on every possible occasion and stamps those who refuse to indulge 
as eccentric or weak. Moreover, a drink should not be ordered for appear¬ 
ances merely and then nipped. If a person does not care for alcohol or finds 
that it disagrees with him, he should neither be misled by custom nor tempted 
by the scoffers. To overcome this custom is the main factor in the fight 
against alcoholism. Education with reference to the uselessness and harm¬ 
fulness of alcohol must be addressed to the public in the widest conception 
of this term, rich and poor, high and low. The campaign of education, and 
the organizations which further it, should be materially supported by the 
government. It is essential that the work be begun in the common schools, 
and that the dangers of alcoholic indulgence be impressed on the minds of 
the children. 

The treatment of the bodily and mental disturbances resulting from the 
abuse of alcohol must be carried out by the physician. Until the arrival of 
the latter, a deeply intoxicated person should be wrapped up in warm 
blankets, hot-water bottles placed in the bed, and strong coffee, without any 
milk, administered. Artificial respiration may sometimes be necessary. 
Delirious cases should be sent to the hospital; if they remain in the house, 
force in restraining them should be avoided as much as possible, as this 
greatly increases their restlessness and resistance. 

ALKALOIDS. —A group of chemical principles found in animals and in 
plants. Many of these alkaloids are useful as medicines; and most of them are 
highly poisonous, even in very minute amounts. The term signifies “like an 
alkali,” and refers to the chemical behavior of these bodies. They are alkaline 
in reaction, form salts with acids, and in many ways they behave like alkaline 
bases. In the animal kingdom alkaloids are not very numerous. The animal 
alkaloids, which have been called “ ptomaines,” and “leucomaines,” usually re¬ 
sult from the breaking down of complex organic substances which contain nitro¬ 
gen. Trimethylamin, one of the simplest of these animal alkaloids, is formed 
in many food products as the result of putrefactive decomposition, the char¬ 
acteristic odor of stale fish being due in part to this substance. Other animal 
alkaloids are guanidin, adenin, neurin, and cholin. In plants the alkaloids 
are very widely distributed, and many plant families contain numerous 
alkaloid principles. Opium, for example, contains at least sixteen diffeient 
alkaloids, morphin being the most important. Cinchona-baik contains over 
twenty different alkaloids, among which quinin is the one most widcly em¬ 
ployed. Other families contain very few. 





Alkaloids 

Allopathy 


THE STANDARD FAMILY PHYSICIAN 


114 


When obtained in the pure state, alkaloids may be either gaseous (as 
mercurialin from Mercurialis annua , a common European plant), liquid (as 
nicotin, in tobacco; coniin , in poison hemlock; and gelsemin , in Gelsemium 
sempervirens , the spreading trumpet-flower of the South), or solid, as is the 
case with the great majority of the alkaloids: morphin, quinin, codein, 
strychnin, physostigmin, brucin, cinchonin, hyoscin, hyoscyamin, cocain, 
caffein, etc. 

Chemically, the alkaloids are all nitrogenous bodies. They contain carbon, 
hydrogen, and nitrogen, and for the most part also oxygen. The simpler al¬ 
kaloids are ammonia compounds, or amines; whereas the more complex mem¬ 
bers of this group are pyridin, or nitrated benzol derivatives. In many in¬ 
stances their exact chemical construction is still undecided. Physiologically, 
the alkaloids are mostly characterized by their very powerful action on the 
nervous tissues. Some alkaloids (as morphin, codein, and hyoscin) depress 
the nerve-cells of the cerebrum, causing sleep, or even death; while others 
(as cocain, caffein, etc.) excite the same cells, preparatory to depressing 
them. Still others (as strychnin) can stimulate the reflex activities of the nerve- 
cells of the spinal cord; while alkaloids as coniin, gelsemin, etc., may com¬ 
pletely paralyze all voluntary muscles, by acting on the muscle end-plates. 
Some alkaloids have a selective action on the sensory nerve-fibers. This is 
particularly true of cocain, which locally applied to a nerve causes it to lose 
its ability to transmit sensory impulses to the brain, thus stopping all con¬ 
sciousness of pain; motor impulses, however, can pass in the same nerve-trunk, 
though not in the same fiber. All alkaloids are more or less poisonous. 
Aconitin in doses of yto grain has caused death; strychnin in doses of ^V 
grain has caused severe convulsions; and morphin in J grain doses has 
caused serious poisoning. Of the various alkaloids used in medicine, quinin 
is one of the weakest. It may be given in doses up to 30 or more grains with 
only mild disturbances of the nervous system. 

It has been only within comparatively recent years that the alkaloids, which 
in many instances represent the efficient part of a complex drug, have been 
isolated. It has often been claimed that homeopathy has brought about the 
use of the smaller doses now employed in medicine. This is not true, or is 
true only as a matter of coincidence. Pharmaceutical chemists have really 
brought about the change, for at the present time one may obtain in a small 
pill or capsule all the active principles in a drug which formerly could be ob¬ 
tained only by swallowing a cupful of a nauseous dose. By isolating the 
alkaloids the same amount of the active principle has been obtained, and the 
patient does not have to swallow the useless decoction containing the alkaloid. 
The chemical laboratory has done the swallowing, as it were, and has given to 
the pharmacist the active principle in compact form. Thus it may be seen 
that the decrease in the size of many doses is not an actual one; it only appears 
so to the unthinking. 





115 


THE STANDARD FAMILY PHYSICIAN 


Alkaloids 

Allopathy 


ALLOPATHY. This term, as applied to scientific medicine, was devised 
by Samuel Hahnemann, the founder of the homeopathic school. He divided 
all remedies into three groups: (i) those which in the healthy subject pro¬ 
duce effects similar to those for which they are prescribed in the sick (homeo¬ 
pathic drugs; see Homeopathy); (2) those which produce a different train 
of symptoms (allopathic drugs); and (3) those which manifest an opposing 
action and depress the symptoms of the disease (antipathic drugs). In the 
latter category Hahnemann included those remedies which brought on sleep 
in insomnia, stimulated the appetite where this had been lost, produced 
catharsis in constipation, etc. These actions are usually found associated, 
with the ordinary household remedies. Hahnemann claimed that the 
homeopathic remedies employed by him were alone effective in disease; 
and he accused his colleagues of using allopathic and antipathic measures 
which were dangerous, because the patients then suffered not only from 
their original illness, but also from the “drug illness” and the other symp¬ 
toms which had been repressed. 

The word “Allopathy ” was used by Hahnemann exclusively as a term 
for producing agitation and as descriptive of a method which, according to 
his views, was detrimental, dangerous, and useless, as compared with the 
procedure devised by himself. With the lapse of time the old controversies 
regarding homeopathic, allopathic, and antipathic schools of medicine have 
all been swallowed up in newer and more important interpretations. Medi¬ 
cine, as a science, has advanced so rapidly that almost every theory fifty 
years old or more has had to be modified. Thus, the word “allopathic,” to 
distinguish it as a school of medicine, has ceased to have any significance, 
and is rarely used at the present time. It never has been a designation for 
any real idea—it was simply a term used by Hahnemann to represent some¬ 
thing different from that which he himself taught. The practical work of 
medicine is carried on by human minds, and must therefore reflect the vari¬ 
ous inclinations and points of view of different individuals. It is a fact that 
there is less divergence of thought in the minds of practitioners of medicine 
at the present day than there has ever been, and there are fewer special 
methods claiming great merit than ever before. This is largely because of 
the closer relations that exist throughout the world; and truths of medicine 
which in times past took centuries in going from country to country are 
now flashed around the world in a few minutes. At the present time, fol¬ 
lowing the announcement of a new medical idea, thousands of physicians in 
all parts of the world are putting the new thought through the tests of expe¬ 
rience ; and the results of these are soon made known in medical literature, 
so that the new idea is established or falls in a comparatively short time. 
This is tending to bring all schools of medicine on a common footing; and 
the innermost parts of China are to-day less isolated from medical research than 
were the countries of Europe one hundred years ago, in Hahnemann s day. 







Almond, Bitter 
Ammonia 


THE STANDARD FAMILY PHYSICIAN 


116 


It is becoming apparent every day that a most important factor of evolu¬ 
tion is mental. People who regulate their lives wisely do not have to suffer 
as much as those who do not; and this important factor even enters into 
the choice of the family physician. A poor doctor gives poor results; they 
may not be detected for a year, or sometimes not in many years, but the 
law of evolution in the mental sphere punishes the man whose judgment 
is defective in the choice of his medical adviser. The layman recognizes 
this, and thus seeks for the best equipped man he can find. 

ALMOND, BITTER. —The ripe seed of the Amygdalus communis amara , 
a native of western Asia and extensively cultivated in the tropics. It is par¬ 
ticularly interesting because it contains an active glycosid, amygdalin , which 
on contact with water develops a very active acid, hydrocyanic or prussic 
acid. See Prussic Acid. 

ALOES. —The dried juice of the leaves of a number of species of the 
genus Aloe , southern members of the lily family, grown in Barbados and 
in other islands of the West Indies, and farther south. Some of the species 
yielding aloes are found also in Africa. The active principle of the drug is 
known as aloin , which is an anthraquinone derivative. It is intensely bitter 
and resinous to the taste, and stimulates the movements of the intestinal 
tract. It causes increased flow of bile from the gall-bladder, but has no 
direct effect on the liver. Its chief action, however, is confined to the lower 
bowel, and it is for this reason that it is so widely used in the treatment of 
chronic constipation. Given alone it is apt to cause griping, and it is widely 
used in pill-form combined with aromatic substances. The usual dose of 
aloes alone is from one to five grains. It is an unsafe remedy for pregnant 
women, especially in large doses. The intestine gradually becomes habit¬ 
uated to it, as to all other cathartics, and it loses its effect with comparative 
rapidity. 

ALUM. —The double sulfate of aluminum and potassium. It is 
largely formed in the manufacture of coal-gas, although a number of miner¬ 
als can be used in its manufacture. Applied locally on the skin, alum has a 
slight astringent action, and is an efficient antiseptic; but its chief action is 
on the mucous membrane where it causes a characteristic puckering and 
astringency, whitening the mucous membrane, thickening it, and making it 
tough. It also diminishes the secretion from the mucous membrane, and 
is widely used as a mouth-wash and in the treatment of leucorrhea. For 
such conditions it should be well diluted, 20 grains of alum to an ounce of 
water being a fairly safe mixture. It is useful as a swab in sore throats; 
and dried alum applied on a piece of cotton to canker-sores is usually effi¬ 
cacious in rendering them sterile and aiding in their healing. 

In large doses alum is poisonous, acting as a metallic astringent. The 
dried alum is a much more powerful caustic than the ordinary crystalline 
alum. Internally alum has been used in the treatment of lead-poisoning, 






117 


THE STANDARD FAMILY PHYSICIAN 


Almond, Bitter 
Ammonia 


but it is doubtful if its internal use is very efficacious. As an emetic it may 
be given in teaspoonful doses. 

AMAUROSIS.— Term designating blindness caused by a disease, prin¬ 
cipally of the retina or optic nerve, occasionally congenital. It may result 
from gout, or from poisoning by wood-alcohol, grain-alcohol, lead, tobacco, 
or anilins. Amaurosis may develop from tumor of the brain, from loco¬ 
motor ataxia, and from brain syphilis. It is not unfrequently found in 
advanced disease of the kidneys. 

AMBLYOPIA. —A dimness of vision; to be distinguished from loss of 
vision, Amaurosis. Many of the conditions causing amblyopia will, if 
operating for sufficient time, cause amaurosis. Thus poisons, such as alco¬ 
hols and lead, may at first cause only partial blindness; but if the poison acts 
for a considerable period of time total blindness may result. In kidney- 
disease amblyopia, at first transitory, may ultimately develop into true optic 
atrophy with resulting blindness. All cases of partial blindness should re¬ 
ceive immediate attention, as they may be precursors of total blindness. It 
should be remembered that there is a form of hysterical amblyopia which 
often baffles all but experts in diseases of the eye and nervous system. 

AMMONIA. —A volatile acrid gas with a burning taste and an extremely 
irritating and suffocating odor. In a concentrated solution it is a very active 
caustic, being capable of burning the skin and mucous membrane. If 
taken internally it acts as an alkaline caustic, burning the mucous membrane 
of the mouth, esophagus, and stomach, and being capable of causing death 
from shock and collapse. The gas itself when inhaled in undiluted form 
may produce death by reason of its irritating action on the glottis, which 
causes the mucous membrane to swell and brings about suffocation. If 
well diluted, as in the frequently used smelling-salts, which consist mostly 
of ammonium carbonate, it has a very pronounced stimulating effect on the 
mucous membrane of the nose, and through these stimulating qualities it 
reflexly strengthens the heart-beat. When combined with aromatic sub¬ 
stances, as in the familiar smelling-salts, it serves a useful purpose as a quick 
heart stimulant, being particularly valuable in fainting, in snake-bite poi¬ 
soning, aixl after anesthetization by chloroform or ether. 

Ammonia-water sufficiently well diluted is a very useful remedy in gastric 
acidity. It is particularly valuable, locally applied, in relieving the irrita¬ 
tion caused by the bites of insects. In the form of aromatic spirits of am¬ 
monia it is a swift, though evanescent stimulant, and is very widely used in 
the treatment of intoxication. Ammonia-gas itself is never used in medi¬ 
cine, but the stronger ammonia-water containing 28 per cent, of the gas, and 
the weaker water containing 10 per cent, are widely employed. The former, 
however, while very useful for household and cleansing purposes, should not 
be used internally. In cases of poisoning resulting from the accidental 
swallowing of strong ammonia-water, it should at once be diluted with water 





Amnesia 

Analgesics 


THE STANDARD FAMILY PHYSICIAN 


118 


and vinegar, and the stomach evacuated as speedily as possible. Ammonium 
carbonate, one of the commonest of the salts of ammonia, is widely used in 
cough-mixtures as a stimulant and expectorant, increasing the flow of mu¬ 
cus, and thus rendering the cough less violent and the mucus less tenacious. 
The chlorid of ammonia is also used for much the same purposes, and in 
the form of troches it is widely employed for the treatment of sore throats. 

AMNESIA (FORGETFULNESS). —See Speech Disturbances. 

AMPUTATION. —An operative procedure, which is not now resorted to 
as frequently as in former years. This is due primarily to the great ad¬ 
vancement in the treatment of wounds, so that many limbs are preserved, 
which formerly would have been sacrificed in order to save the life of the pa¬ 
tient. Amputation is, moreover, not as dangerous, and this is also the 
result of modern attainments. Death rarely occurs in consequence of the 
operation itself, and the newer methods aim to secure a stump which will 
remain serviceable to the patient. The knowledge of the manufacture of 
artificial limbs has also made great strides, and there are models provided 
with functionating knee-joints. Those who are unfortunate enough to re¬ 
quire amputation of a limb owing to severe injury or disease, have the pros¬ 
pects of an existence much more comfortable and useful than would have 
been their lot in former days. 

AMYLENE HYDRATE. —A complex alcohol widely used as a sleep- 
producing remedy. It is of particular value in inducing sleep when the 
sleeplessness is due to worry and overwork and not accompanied with pain. 
It is usually given in doses of from 15 drops to one-half teaspoonful. In 
large doses it depresses the heart and brings about a condition almost iden¬ 
tical with deep intoxication. 

AMYL NITRITE.— A nitrite prepared from one of the higher alcohols 
and being a volatile oily liquid with a very characteristic banana-like odor. 
It is rarely used internally, being administered in the form of a vapor, five 
drops of amyl nitrite usually being enclosed in a glass-pearl. This is broken 
in the handkerchief and the volatile gas inhaled. Taken in this manner it 
causes a distinct sense of fulness in the head, which is followed by dilatation 
of the blood-vessels of the face, roaring and buzzing in the ears, and even by 
a certain amount of staggering and unconsciousness. The respirations are 
hurried, the heart-action is increased in force and rapidity, and the blood- 
pressure sinks rapidly. The chief action of the drug is on the blood-ves¬ 
sels, where it acts on the unstriped muscle-fibers, causing them to relax. 

Amyl nitrite is used particularly in those diseases in which sudden acute 
contraction of the blood-vessels may result in sudden death or serious acci¬ 
dent (as in angina pectoris), and in some instances it may be efficacious in 
cutting short an epileptic attack. It is used also in the treatment of some 
forms of sick headache, especially when accompanied by high pulse-tension, 
cold and clammy skin, pinched nose, and general discomfort. Its action is 






119 


THE STANDARD FAMILY PHYSICIAN 


Amnesia 

Analgesics 


very rapid, but also very evanescent, and it is not well adapted to contin¬ 
uous use. 

AMYLOPSIN. —A starch-digesting ferment found in the pancreatic juice. 
It has the power of converting about twenty-five times its own weight of 
starch into glucose. See Pancreas in Introductory Chapters, s. v. 
Organs of Digestion (p. 58). 

ANALGESICS. —Agents that diminish pain. These may be either agents 
that are applied locally, and exert their influence on the ends of the sen¬ 
sory nerves; or they may be remedies which are given internally and 
either act on the centers of consciousness in the brain, benumbing the sense 
of pain, or exert their influence on the sensory end-organs through the me¬ 
dium of the blood-vessels. In the former class belong those that act on the 
skin and those that act on the mucous membrane, many of which are very 
widely used in medicine at the present day. As the skin does not absorb 
very readily, acting usually only through its sweat-glands, many analgesics 
which are extremely effective when applied to the mucous surfaces have little 
or no action on the skin. Cocain is an excellent illustration of this general 
principle. 

Of the analgesics that are used on the skin, cold and heat are of immense 
importance. Ice-bags and hot-water-bags are very useful in reducing the 
pressure of inflammation, thus indirectly alleviating pain. Freezing mix¬ 
tures, such as ethyl chlorid, etc., are highly efficacious in causing local anal¬ 
gesia, and these mixtures are very frequently employed to render the skin 
insensible, so that minor operations can be performed without pain. 

A large number of aromatic compounds, particularly combinations of 
phenol, of menthol, of thymol, etc., are of immense service in relieving pain 
by local application. Thus, oil of wintergreen, which is so very widely 
utilized for local neuralgias and for muscular affections resembling rheu¬ 
matism, is one of these aromatic compounds, being methyl salicylate, which 
is closely related to carbolic acid. 

Another class of remedies that are utilized as local analgesics on the skin 
are the various preparations of belladonna, particularly ointments and plas¬ 
ters. Belladonna has the property of destroying the sensibility of the ends 
of the sensory nerves in the skin, which accounts for its efficacy in neuialgias 
and painful affections of the muscles, such as lumbago, backache, stiff 
neck, etc. 

The local analgesics most widely used on the mucous membranes are 
cocain and its allies. The action of these agents on the inflamed mucous 
surface is rapid, but very evanescent, and it should never be forgotten that 
the relief from pain is often gained at the expense of acquiring a lifelong and 
destructive habit. Within recent years a number of closely related com¬ 
pounds have been used for local analgesics on mucous surfaces, eucain, 
holocain, etc., being examples. In addition to these a number of benzoic 









Anatomy 

Anemia 


TIIE STANDARD FAMILY PHYSICIAN 


120 


acid derivatives have also been widely employed, and have the great value 
of being more persistent in action and less liable to induce habituation. 
These local analgesics for the mucous membrane are of particular value in 
inflamed conditions of the nose and throat, especially in tuberculous laryn¬ 
gitis and in ulcer or cancer of the stomach. 

Of the analgesics that are used internally it may be said that it is fortu¬ 
nate that medicine has at its command a large variety. Whereas in ancient 
times opium was almost the only pain-destroying remedy which the physi¬ 
cian possessed for internal medication, 
he now has at his command twenty or 
thirty excellent remedies for producing 
the desired result. Naturally opium 
stands at the head of the line as the 
most effective pain-annulling remedy. 
But its use is attended with great dan¬ 
gers, and countless lives are sacrificed on 
the altar of morphin and opium habits. 

Of the newer analgesics, antipyrin, 
acetanilid, phenacetin, and their allies 
represent the most important groups. 
These are particularly valuable in the 
treatment of neuralgic affections, head¬ 
ache, menstruation pains, influenza 
pains, and the various pains in muscles and joints which result from 
acute and chronic rheumatism, etc. Their use is attended, however, 
with constant danger; and many instances of severe poisoning and even 
death are recorded from the too free and indiscriminate taking of these 
remedies. They are quite dissimilar in their action in certain indi¬ 
viduals, and no layman should dose himself with them or with any of the 
many headache-powders and pain-destroying remedies that are so widely 
placed on the market. The great danger that is caused by these drugs, 
particularly by acetanilid, and in a less degree by the phenetidins, is the 
destruction of the red blood-cells. This is an accident which is often 
very serious. 

ANATOMY, HISTORY OF. — See Medicine, History of. 

ANCHYLOSTOMIASIS. —Term denoting a special disease which was 
first observed in bricklayers and in workers in tunnels, but at present is 
found extensively in mines throughout the world, having been transported 
from place to place by infected miners. It is caused by a worm ( anchy - 
lostoma duodenale; see Fig. 72) which settles on the mucous membrane 
of the small intestine, and lives on the blood it sucks. This results in a 
considerable degree of anemia, which may be accompanied by bloody 
diarrhea, respiratory difficulties, palpitation of the heart, dropsical swell- 



Fig. 72. Anchylostoma duodenale (the 
cause of Anchylostomiasis). A, male; B, 
female. 












121 


TIIE STANDARD FAMILY PHYSICIAN 


Anatomy 

Anemia 


ings, great weakness, etc. The disease is recognized by microscopical 
examination of the feces, in which the eggs of the worm may be found. 
Within recent years it has become apparent that this disease is very common 
in the southern United States; and it has been found that a distinct species, 
Anchylostoma ( Uncinaria) Americana , is responsible for the American 
disease. 

Treatment consists of medicines (to be prescribed only by a physician) 
for killing the worms, and of purges and enemas. The chief prophylactic 
points to be observed are:—disinfection of the intestinal evacuations, pro¬ 
vision of pure drinking-water, and the observance of scrupulous cleanliness 
on the part of the workmen. The diseases caused by tape-, thread-, and 
pin-worms are described under separate paragraphs. It should be added 
that frequently, especially in the case of children, all sorts of complaints are 
ascribed to “worms” which often are due to different and more serious 
causes. Therefore, if more serious disturbances appear, it is wise to have 
the child examined by a physician. A microscopical examination of the 
feces should be made in every case called “worms.” 

ANEMIA. —Deficiency of hemoglobin or of red blood-corpuscles. Accord¬ 
ing to the views of the laity, there is no complaint easier to recognize than 
an anemic condition of the blood. Paleness of the skin is admitted to be an 
infallible sign of poor blood, and if a member of the family is stated to be 
suffering from this complaint, the question is almost universally asked, 
“shall not he or she, as the case may be, take iron?” 

In the presence of such generally accepted knowledge, any further ex¬ 
planations would appear superfluous. For the layman argues that as the 
pale condition of the skin which he sees and the various symptoms of which 
the patient complains are due to anemia, and that the impoverished state 
of the blood is caused by a lack of sufficient iron in the system, the only 
rational treatment by which all the disturbances may be allayed, is to ad¬ 
minister iron freely. Nevertheless, it is very easy to prove that these con¬ 
clusions are superficial and erroneous, and that iron is not an infallible 
remedy for this affection. A gardener would certainly ridicule the notion 
that the fading and blanching of the leaves of a plant could be prevented 
by enriching the soil with iron. Every one who is conversant with plant 
life knows that in producing this condition a great number of factois aie 
at work, among which may be included insufficient or overabundant light, 
too much or too little heat or moisture, the composition of the soil, in which 
of course the proper modicum of iron must be present, and finally, parasites 
either resident on the plant or in the surrounding eaith. 

That iron alone does not meet all the indications with which it is cred¬ 
ited, is evidenced by the fact that there is appearing a constantly inci casing 
number of iron preparations, which are claimed to be more easily digested 
and therefore possessed of greater tonic properties; and furthermoie that 





Anemia 


THE STANDARD FAMILY PHYSICIAN 




in successful cures, important hygienic rules have been prescribed in addi¬ 
tion to the iron medicine. Constant experience and careful observation 
must make it plain to all who are willing to learn that, particularly in these 
disorders of the blood, it is' extremely essential that each individual case be 
submitted to the test of a medical examination, and that treatment be de¬ 
termined accordingly. For we are not merely concerned with giving an 
appropriate name to a disease based on its external characteristics, but we 
are required as a precautionary measure to determine the cause, the error 
in the conditions of life, which brings about these disturbances. 

The blanching of the leaves has been chosen as an illustrative example 
of the various causes which may underlie what is apparently but one dis¬ 
ease, because this change in color bears a close resemblance to that which 
gives rise to the popular conception of anemia. And not only this, but in 
both of these manifestations there is, in so far as a comparison can be drawn 
between animals and plants, a similar pathological process underlying each. 
The green color of the leaves is due to a coloring agent, the chlorophyl, just 
as the red color of the blood is due to a similar agent, the hemoglobin. 

The blood consists not only of an albuminous fluid, in which are con¬ 
tained the numerous salts and other substances necessary to the growth of 
the body, but it also contains an enormous number of minute cells of various 
forms and sizes, which according to their color are described as red or white 
blood-corpuscles. The red cells, which are far more numerous than the 
white, contain the red coloring-matter, which gives to the blood and the 
tissues supplied by it their characteristic color. This substance permits 
the red cells to absorb and retain the oxygen supplied to the body .through the 
agency of the respiratory organs. The more completely this is done, the 
more intense is the red color of the corpuscles, and the greater their 
ability to carry out the metabolic exchange to the welfare of the tissues in 
the body. A rugged, blooming color of the skin may therefore with entire 
justice be looked upon as an evidence of health. The complexion does not, 
however, depend entirely on the number, nor on the intensity of the color, 
of these corpuscles, but also on the degree of dilatation of the blood-vessels 
in the skin and on the transparent and tender character of its layers. For 
these reasons it is apparent that changes in the complexion are dependent 
upon: (i) a decrease in the number of the red blood-cells; (2) a diminution 
or change in the character of the red coloring-matter; (3) a true scarcity of 
blood; (4) an irregular distribution of the blood, there being more in the 
internal organs than at the surface of the body; and (5) the character of the 
superficial layers of the skin, which are sometimes particularly rich in a 
deposit of yellow or dark pigment, thereby offering an obstruction to the 
passage of the light-rays emanating from the red blood-cells. There are 
families, and even races, who are possessed of a pale, tender, and yellowish . 
skin, without being at all anemic; and it is necessary for the physician to 





123 


THE STANDARD FAMILY PHYSICIAN 


Anemia 


determine whether the pale or yellowish complexion has developed grad¬ 
ually, or whether it is peculiar to the family in question. 

A transitory blanching of the skin is often seen in delicate and frail per¬ 
sons, who, especially during the winter, afford the impression of being 
anemic. In other cases nervous influences may serve to direct a greater 
amount of blood to the internal organs than goes to the skin. It is well 
known that persons suffering from cold hands and feet often complain of a 
rush of blood to the head or give evidences of abdominal congestion as shown 
by various digestive disturbances and hemorrhoidal conditions. Further¬ 
more, it is a matter of common observation that anemic individuals may 
suddenly show a bright red flush, which clearly proves that a pale complex¬ 
ion need not necessarily be due to a lack of blood or insufficient activity of 
the red blood-cells, but may be caused by a faulty distribution of the fluid 
dependent upon nervous influences. When this condition is accompanied 
by vertigo, noises in the ears, and cardiac palpitation, it may be taken for 
granted that the symptoms are those of actual anemia, and that as the blood 
rushes to the surface of the body, the internal organs are more or less de¬ 
pleted of their proper quantity of blood. The flushing of the face in such 
cases is often falsely attributed to congestion of the brain, whereas the very 
opposite condition, an anemia, is present. The following varieties of 
anemia must be distinguished: 

(1) Chlorosis , which depends on the diminution to a greater or less 
extent of the coloring-matters of the blood. The name which is applied 
to this condition is derived from the Greek, and refers to the characteristic 
yellowish-green complexion of the afflicted individuals (see Plate XIV., 
Fig. 4). 

(2) Anemia , which refers to an insufficiency of the essential components 
of the blood,—albumin, salts, etc. The watery constituents of the blood 
may be increased, however, so that the total quantity of fluid remains the 
same, or it may even be increased. This condition is termed hydremia or 
“watery blood.” In the severer forms of this trouble, the total amount of 
the red coloring-matter may also be decreased, and on puncturing the skin 
an almost colorless drop of blood appears, which is only slightly sticky and 
coagulates with difficulty. This may be looked upon as due to a faulty 
admixture of the elements of the blood. It is not in all cases due to dietetic 

causes, that is, to unsuitable nourishment. 

(3) Complete Anemia or Exsanguinity, characterized by the diminution 
of the blood in the body, in some instances to such an extent that on piieking 
the finger no blood flows from the wound. This condition is usually brought 
about by the sudden loss of a large amount of blood, or is due to long-con¬ 
tinued, severe illness. 

(4) Local Anemia or Depletion , a condition of abnormal distribution of 
the blood in some particular region of the body. 






Anemia 


THE STANDARD FAMILY PHYSICIAN 


124 


(5) Leucocythemia , a disease which, in addition to other changes, is 
characterized by an often enormous increase of the white blood-cells, and 
in the severe cases accompanied by a diminution in the number, and a 
change in the shape, of the red cells. Although the well-marked paleness 
which is present in this disease may at first lead to confusion with ordinary 
anemia, the true nature of the condition soon becomes evident, as the patho¬ 
logical processes in the blood-forming organs, the spleen, the lymphatic 
system, and the marrow of the bones, lead to well-defined enlargement of 
the various lymphatic glands. 

The facts that pale persons may be neither chlorotic nor anemic, that 
anemia of a mild degree may not always be evidenced by a pale complexion, 
and that several processes may be concerned in the production of this class 
of diseases, make it clear that an exact diagnosis of the complaint can not 
be made from the mere impression afforded by the color of the skin. It is 
always essential to make a careful chemical and microscopical examination 
of the blood of each patient. When in any given case it has been deter¬ 
mined that some change in the blood is the basis for the symptoms of which 
the patient complains, and after it has been decided which of the organs 
concerned with the formation of the blood, is diseased, it still remains to 
remove the cause of the disturbances before any definite indications for 
the treatment can be formulated. It is necessary, therefore, in every case 
to determine whether the therapeutic measures shall be directed to any 
one organ which may happen to be diseased, or whether unfavorable 
and unhygienic conditions are alone at fault and must accordingly be 
corrected. 

It is evident that the faculty of inspection, however acutely it may be 
developed in the physician, does not offer any royal road to correct diag¬ 
nosis in the domain of blood-disorders. The generally accepted opinion of 
the laity in reference to the ease with which anemia may be cured, and that 
the administration of iron is the great panacea, may well be met with ridicule 
by those who are acquainted with the complex constitution of the blood 
and the many and varied causes which may underlie changes in its compo¬ 
sition. The mistaken conception, that anemia is due entirely to the lack 
of a sufficient quantity of iron in the blood, may be traced, as in numerous 
other instances, to a confusion of the effect and the cause. It is true that 
iron is lacking in the blood, but only so because the blood-forming organs, 
and among these must be included the digestive system, are not function¬ 
ating properly. The blood-cells become diseased because these organs in¬ 
terfere with the absorption of the iron present in the food; and also because 
they do not develop in sufficient amounts other constituents which are nec¬ 
essary components of the blood. In the majority of cases, therefore, a lack 
of iron is not the cause of the illness, but the latter is the immediate result of 
a weakness of certain organs. 





THE STANDARD FAMILY PHYSICIAN 


Anemia 


125 


The more important causes of blood-disorders must be definitely known 
if it is intended to overcome them. In the first place they may consist of 
some constitutional failure; that is to say, the blood circulatory system of 
some individuals may be afflicted with a certain predisposition to these dis¬ 
orders, just as a person may squint from the time of birth, or present crooked 
limbs. Then, again, the cause may arise during subsequent development. 
It is known that the transition from childhood to puberty is marked by many 
changes. In the female, as the time of puberty is reached, there occur 
numerous changes in the circulatory system associated with the develop¬ 
ment of sexual activity, and for this reason girls, during certain years of 
their lives, are more apt than boys to become afflicted with disorders of the 
blood, especially if their surroundings are unfavorable. But even where 
the conditions are more favorable, the transition may sometimes be accom¬ 
panied by changes involving the entire system, which may persist for a long 
time and even extend through life, unless this period of development is per¬ 
mitted to go forward under the most careful prophylactic measures. Dur¬ 
ing this time girls should not be permitted to indulge in overexertion involv¬ 
ing either the body or the mind, and their nutrition should be carefully looked 
after. Boys should receive similar care during this period of development, 
for they also exhibit general changes as well as particular ones in the circu¬ 
latory system, but in a less marked degree than girls. It is incorrect, there¬ 
fore, to associate anemia with the female sex entirely. 

Abnormal external influences may cause anemia, if they exert their 
effects on the system for a protracted period, or continuously, and in this 
way inhibit the activity of the individual organs. Among the more impor¬ 
tant of these conditions may be mentioned: insufficient nourishment; dark, 
unhealthy, cold, and damp living-quarters; the effects of extreme heat or 
cold either in the open air or in poorly ventilated work-rooms; overexertion, 
either bodily or mental; lack of sufficient sleep or improper sleeping accom¬ 
modations; any occupation which necessitates a stooping posture so that 
proper respiration is interfered with; excessive or insufficient muscular 
activity; exertion which includes but one side of the body; and, finally, 
marked mental disturbances. Attention must also be directed to the 
harmful character of the corset, which not only interferes with the normal 
expansion of the thorax, and the entrance of the air to the lungs, so that 
the ready combination between the oxygen and the red blood-cells is pre¬ 
vented, but also exerts pressure on the important digestive organs, the 
stomach and liver, and in this way obstructs the abdominal circulation and 
the necessary movements and expansion of these organs. Indigestion and 
constipation result from the latter conditions and are accompanied by 
numerous painful sensations. 

It is the function of the physician to determine which of these numerous 
factors are the essential causes of anemia, bearing in mind that season an(* 





Anemia 


THE STANDARD FAMILY PHYSICIAN 


12G 


other circumstances may largely influence these conditions. I hus, many 
persons are capable of doing considerable muscular work in the winter, 
which it would be impossible for them to accomplish in the summer; while 
others apparently are harmed only by their exertions during the winter, 
although this may be due to the fact that they can not get along without the 
proper amount of sunlight or that an atmosphere which is very dry or very 
moist has an unfavorable influence on respiration and muscular activity. 
The change from one season to another has an important bearing on the 
production of anemia and other blood-disorders, so that in some latitudes a 
summer and a winter anemia can be differentiated; and persons are seen 
who suffer regularly either in one or the other of these seasons from symp¬ 
toms of anemia. This is due to the fact that the changes induced in the 
blood circulatory system by the passage of the seasons can not be withstood 
on account of some constitutional weakness or especially unfavorable 
surroundings; or that the influence of some characteristic attribute of the 
seasons,—heat, cold, dampness, etc.—can not readily be overcome. The 
transition must be gradual in order that the individual may become ac¬ 
customed to the change; and the production of severe catarrhal troubles 
with the advent of either spring or fall is a matter of common observa¬ 
tion. 

Marked changes in the circulatory system and in the blood may be 

caused by a great variety of diseases, among which may be primarily men¬ 
tioned those of the digestive tract, the infectious diseases, and inflamma¬ 
tion of the kidneys. Both anemia and chlorosis may develop in children 
after an attack of summer diarrhea, measles, scarlet fever, malaria, diph¬ 
theria, etc., or in adults after typhoid, although the disease may have ap¬ 
peared very mild and run a short course. It is natural to suppose that the 
various chronic diseases of important organs, such as chronic pleurisy, pul¬ 
monary tuberculosis, cardiac diseases, Bright’s disease, and long-continued 
suppuration, should lead to marked changes in the character of the blood. 
In some cases intestinal parasites may be the cause of the anemia, and 
patients should therefore not be definitely treated for the condition unless 
an examination of the stools in suspicious cases has been made. Many a 
case of anemia with severe digestive disturbances has been cured by the 
administration of a vermifuge. During late years new forms of intestinal 
parasites have been imported and are now endemic. A condition now 
almost epidemic among miners is the “hook worm” disease, or “tropical 
chlorosis,” which is due to a round worm, the Anchylostoma duodenale. 
This disease has been found to be particularly common in the southern 
United States. Pregnancy and labor also exert their influence on the 
state of the blood. 

The surroundings of the patient must be taken into consideration when 
there is some doubt as to the cause of the disease; for these may lead to 











127 


THE STANDARD FAMILY PHYSICIAN 


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the production of an anemia where a tendency is present in the individual, 
or, if only slight evidences are at hand, may bring about a more severe 
degree of the affliction. Even hygienic measures which may be of signal 
value under certain circumstances, may sometimes lead to a very harmful 
result, because they have been falsely applied. For example, when ap¬ 
parently perfectly healthy children who are growing actively and using up 
all their energies in accomplishing this growth, show a certain degree of 
fatigue and lassitude, because the nourishment demanded by the muscles 
is greater than the system can supply at once, it is an error to subject these 
children to cold baths or to urge them to swim, with the idea of strengthen¬ 
ing their muscular system. As a result of such treatment very severe de¬ 
grees of anemia may develop, because the body is unable to meet the double 
demands necessitated by increased muscular growth and the effort to keep 
warm (see Swimming). 

Harm is also done by the well-meant efforts to improve the anemic- 
looking child by attempts at overfeeding with plentiful and rich food. A 
weakened digestion and insufficient secretion of gastric and intestinal juices, 
together with diminished muscular exertion, does not require an abundance 
of eggs and meat. Even milk taken in large quantities may do harm, if the 
desire for albuminous foods is indicated by an improved appetite. The 
giving of wine had also best be omitted, for this beverage does not supply 
the constituents which are lacking in anemic blood. Although red wine, on 
account of its supposed contents of iron, is often warmly endorsed for this 
purpose, it fails to accomplish the object sought. 

The manner of life of a child, although carried out under what are ap¬ 
parently the most favorable circumstances, exerts a harmful effect on the 
development of its body in more cases than is generally supposed. First of 
all must be mentioned the influence of the school, the confinement in poorly 
ventilated school-rooms, and the development of the mental, at the expense 
of the bodily, functions; insufficient exercise in the open air contributes to 
the neglect of the latter, especially if a portion of the time after school-hours 
is given up to music or other accomplishments. The effects of life in large 
cities and the demands of present-day society also exert their harmful influ¬ 
ences. Children and young people do not get enough sleep, and a lack of 
sleep is as distinctly harmful as insufficient nourishment. Early school- 
hours rob the children of the large cities, where a timely retirement is often 
prevented by a multitude of circumstances, of a considerable portion of the 
refreshing morning-sleep. No words need be wasted in doing more than 
allude to the baneful effects of social amusements which extend into the 
early morning-hours, and of the exertion attendant upon dancing in hot 
and close rooms. Happily the love of outdoor sports partially counter¬ 
balances this tendency, but these should be indulged in with the thought 
uppermost in mind that the abuse of muscular activity, especiallv in the 







Anemia 


THE STANDARD FAMILY PHYSICIAN 


128 


undeveloped body, may do a great deal of damage, and in certain grades of 
anemia must be entirely avoided. 

The symptoms of anemic persons are due to the fact that the poorly con¬ 
stituted blood can not sufficiently nourish the various organs. Up to a cer¬ 
tain point this is made up by more active circulation and deeper respira¬ 
tions; that is to say, both the lungs and the heart are compelled to work 
harder and faster in order to supply the body with the necessary quantity 
of oxygen. When this can no longer be kept up, those organs which are 
most in need of constant and appropriate nourishment—the heart, muscles, 
and brain—are the first to exhibit an inherent weakness. In anemic and 
chlorotic individuals the breathing is, therefore, more rapid, and the pulsa¬ 
tion faster than in healthy persons. The former often complain of a sudden 
respiratory embarrassment which is looked upon as asthma; excitement or 
exertion, especially rapid walking or going up-stairs, “takes their breath 
away,” and they become afflicted with palpitation. The muscles, as is 
shown by their bright red color, contain a large amount of the blood-coloring 
matter, the hemoglobin, and even during quiet they require large quantities 
of oxygen. Naturally enough this demand for oxygen and hemoglobin is 
quickly increased when these muscles are thrown into a state of activity; 
and if the blood is deficient in these constituents, the other organs, particu¬ 
larly the brain and skin, will suffer because their allotment is drawn away 
to supply the muscles. As a result the patients are seen to grow pale at 
almost every exertion, and they complain of headaches, vertigo, and flick¬ 
ering before the eyes. 

When the blood supply is insufficient even for moderate bodily move¬ 
ments, there soon ensues a feeling of fatigue, and sometimes this is accom¬ 
panied by severe and obstinate muscular pains. These are especially 
marked in the calves of the legs and in the back, and this fact should be 
borne in mind when chiding anemic persons for the stooping posture which 
they usually assume. In the course of time the muscles of the chest and 
the abdomen also become sensitive, and the patients complain of constant, 
or transient, deep-seated pain, often in the early morning, in various local¬ 
ities, especially between the ribs and in the pit of the stomach, also of diffi¬ 
cult respiration and abdominal cramps. On account of the sensitiveness 
of the abdominal muscles, the pains are increased at every meal time, often 
to such an extent that the patients will forego their food rather than endure 
the discomfort. The abdominal distress is sometimes mistakenly attributed 
to disease of the internal organs, such as the liver and stomach; and the pain 
in the chest to affections of the pleura, the lung, or the heart; sometimes it 
is difficult even for the physician to make a definite diagnosis. Attacks of 
pain in anemic persons, which are usually designated as neuralgic, are often 
as a matter of fact nothing but muscular pains, although on account of the 
sensitiveness of the nervous system, nervous pains do occur. Anemic per- 


129 


THE STANDARD FAMILY PHYSICIAN 


Anemia 


sons are readily tired, exhibit a feeling of languor, and are usually chilly, 
although they are subject to congestion of the blood in various regions. 
They are often troubled by toothache and headache, very irritable, easily 
excited, and either have difficulty in falling asleep or else are constantly 
drowsy. In the latter case prolonged sleep is most essential. 

In the severer grades of anemia the complexion appears yellow or a 
greenish yellow; and the skin, owing to the more watery character of the 
blood, loses its elasticity and pliability and becomes puffy. Aided by a 
weakened heart, this also brings about a swelling around the ankles and over 
the shins, especially in persons who have to stand a great deal. An im¬ 
provement in the condition of the blood rapidly causes the disappearance of 
these symptoms. As a rule the urine is pale and watery in proportion to 
the paleness of the skin, and the bile likewise is not so deeply stained, so that 
the stools have a very light color. As the food is not properly assimilated 
by the body a great deal of it remains undigested as a waste product, and 
various digestive disturbances result. Hunger, which serves as an indica¬ 
tion of the necessity for taking food, and appetite, which is the expression of 
a desire for some particular kind of food, both become lessened; or there may 
be alternating periods of extreme greed for food, followed by a complete loss 
of appetite and an aversion against food, especially against a stimulating 
or albuminous diet. The intestinal movements become steadily lessened 
and constipation results with much flatulence and colicky attacks, because 
the gut may become very irritable and the accumulated masses of hard fecal 
matter can only be evacuated with difficulty. 

Various disturbances of the appetite may appear before or after the con¬ 
dition just described is developed, although hunger, properly speaking, may 
be entirely absent. The patients manifest an uncontrollable desire for cer¬ 
tain substances which either serve as substitutes for those which are neces¬ 
sary for proper digestion, or as chemical or mechanical counter-irritants 
against abnormal sensations. Some of these increase the secretion of the 
gastric juice, and the act maybe compared to the ingestion of sand by birds, 
which acts on the stomach-juices or aids in the mechanical disintegration of 
its contents. An interesting example is afforded by the dirt eaters of the 
South, who almost invariably are anemic by reason of intestinal parasites, 
Uncinaria Americana. A definite indication for medical treatment is af¬ 
forded by the well-marked desire of these patients for salty or acid dishes, 
which make good to a certain extent the deficiency of hydrochloric acid in 
the gastric secretions. This desire may be gratified without fear, but ab¬ 
solute denial should be extended to the longing for various indigestible arti¬ 
cles such as chalk, coffee-beans, etc., wffiich not only irritate a stomach 
poorly supplied with blood, but do not afford any nourishment to the body. 
The apparent advantage gained by the increased secretion of sali\ a and 
gastric juice which is brought about by the ingestion of these substances, is 






Anemia 


THE STANDARD FAMILY PHYSICIAN 


130 


more than offset by the introduction into the stomach of indigestible mate¬ 
rials, and the physician may well direct his attention to more suitable 
remedies. Neither is it wise to give way to the repeated desire for strong 
spices; in such cases the digestive secretions are sufficiently stimulated by 
eating a little dry bread with salt, dried fruit, simple bitters (herb teas), or 
by the administration of medicines prescribed by the physician. Meat and 
albuminous foods require a considerable amount of digestive fluid for their 
complete and proper digestion, and for this reason their use in anemic 
patients should be restricted as much as possible; if given, acids should 
at the same time be administered. When the feeling of hunger is absent, 
the diet had better consist principally of rice, mashed potatoes, toasted 
bread, fruit, buttermilk, white (cream) cheese, and farinaceous soups with 
milk. 

The more advanced disturbances of nutrition become manifest in various 
organs in the course of the disease. Gastric ulcers and hemorrhage may 
result, also nosebleed. The monthly periods may be diminished or ex¬ 
tended, and such irregularities are among the earliest and most important 
evidences of abnormalities in the blood. It must not be forgotten that an 
apparently free bleeding does not necessarily signify the loss of any con¬ 
siderable amount of blood, as this fluid possesses marked staining powers; 
on the other hand, a comparatively small showing may consist entirely of 
pure blood. Any considerable loss of pure blood from this source may in 
itself be a contributing factor in producing anemia. Also other disturb¬ 
ances may result, among which may be mentioned mucous or purulent dis¬ 
charges from the female genitals, which are apt to bring on a great deal of 
discomfort and soreness of the surrounding parts if neglected. That bad 
hemorrhages may be the direct result of an impoverished condition of the 
blood is readily explained by the fact that the poorly nourished blood¬ 
vessels are unable to retain the contained blood; and in the severest grade, 
the pernicious anemia, hemorrhage of an extreme and dangerous degree 
may take place. 

Insufficient nutrition of the heart reduces its propulsive powers, and as 
a result the extremities—the tip of the nose, the ears, the fingers, and the 
toes—do not receive their full amount of blood, and become blanched and 
cold. Under these conditions the lungs are likewise incompletely nour¬ 
ished, and in consequence readily become diseased; it is well known that 
pulmonary tuberculosis is frequently associated in its early stages with the 
symptoms of anemia. Respiration in anemic individuals must therefore be 
carefully watched. They should not be permitted to wear corsets, and the 
danger of catching cold should be guarded against by the wearing of suit¬ 
able underclothes. Appropriate respiratory exercises under medical direc¬ 
tion are to be recommended. The lungs must be carefully watched when 
obstinate, chronic digestive disturbances are present, as these are frequently 









131 


THE STANDARD FAMILY PHYSICIAN 


Anemia 


the forerunners of consumption, or else favor its development, because the 
entire body is insufficiently nourished. 

The appearance of patients afflicted with the severer grades of anemia 
may be difficult to distinguish from that associated with the final stages of 
cancer; they have a waxy look, are incapable of any exertion, display a 
tendency to fainting-spells, suffer from attacks of distressing vomiting, are 
unable to assimilate even the lightest foods, and are subject to hemorrhages 
in the skin and in the various internal organs. These symptoms indicate 
what is known as pernicious anemia. 

It is to be hoped that this account has made it clear that a disease so 
varied in its aspects can not be recognized as readily as the popular concep¬ 
tion would lead one to believe, but that its type and its degree must be based 
on an intimate knowledge of the workings of the human body and of its re¬ 
quirements. The treatment, although considered a simple matter by the 
laity, is, on the contrary, surrounded by many difficulties. More is required 
than the administration of a universal “cure-all.” The causes of the trouble 
must be definitely determined; and, in the majority of cases, these must be 
removed and a complete change in the manner of living prescribed. From 
what has already been said, it is evident that there may be many remedies 
which may be attended by an apparently favorable result when applied to 
the treatment of this disease. They seem efficient because the latter presents 
extreme variations in form and degree and may be due to a great variety of 
causes. What is appropriate and effective in one case may produce harm 
in another, because it is not only necessary to treat the anemia or the chlo¬ 
rosis, but the numerous contributing causes must be laid bare and removed; 
and the treatment does not consist merely in the administration of iron, 
hemoglobin or pepsin, hydrotherapeutics, warm baths, mountain- or sea-air, 
nor of gastric lavage, or venesection. The choice of a course of treatment, 
and its details, depends on the circumstances associated with the individ¬ 
ual case, and these can be ascertained only by careful and painstaking 
observations. 

Many cases of anemia require no specific treatment, it being merely nec¬ 
essary to remove certain harmful influences and then to prescribe rules for 
a more healthful manner of life. In some cases such measures as exercise, 
cold, fresh air, and forced nutrition, which are otherwise of value, may be 
productive of harm rather than of good. Above all, it should be borne in 
mind that it is not possible to accomplish by radical measures that which 
can only be secured by carefully building up the general strength; and where 
there is well marked diminution of muscular power, complete rest is of 
the greatest importance to the patient. Persons affected with the severer 
grades of anemia must be treated at the first attack with as much consider¬ 
ation as would be extended to a patient ill with fever; and if a recurrence 
takes place, as occurs quite often, the manner of treatment should be like 







Anesthesia 

Anesthetics 


THE STANDARD FAMILY PHYSICIAN 132 


that given to an individual suffering from a constitutional or chronic disease. 
This means more or less continued rest in bed, or, during warm weather, 
the recumbent position in a place where the patient may be bathed by the 
rays of the sun, care being taken that the person is not clothed too lightly. 
Not until the strength has visibly improved is any recourse to be had to 
systematic muscular exercise. 

The recurrence of the disease, of which we have just spoken, affords 
proof that even the milder degrees of anemia must be seriously considered, 
and that the treatment must not be discontinued with the disappearance of 
symptoms which are plainly evident and the removal of which is considered 
by the laity to amount to a cure of the disease. A complete cure can not 
be spoken of until the abnormal conditions of the blood and vascular sys¬ 
tem, which have been described, fail to reappear even when the patient 
must of necessity return to more unfavorable conditions of life and sur¬ 
roundings. 

ANESTHESIA.—The impairment or loss of sensibility, due to action on 
the sensory nervous system. Such anesthesia may be concerned with the 
sense of general sensibility of touch or of pain ( analgesia ); or it may refer 
to the loss of sense of heat or cold. It may refer also to loss of sensibility of 
a special sense: as anosmia , or loss of the sense of smell; blindness , or loss 
of the sense of sight; deajness , or loss of the sense of hearing; ageustia , 
or loss of the sense of taste. These anesthesias, general or special, may be 
partial or complete; if due to a wound of the external part of an organ of 
sense, the anesthesia may be termed peripheral; if the loss is in the brain 
centers, it is frequently termed a central anesthesia. Anesthesias may be 
functional, when due to hysteria, and are then not true anesthesias; or 
they may be due to actual loss of nerve-substance. Their distribution is 
well localized and affords a fascinating problem for the nerve specialist. 
Agents are known that can bring about states of anesthesia, which may 
be local or general. Thus, the use of cold, or of cocain, may cause a local 
anesthesia to pain; while ether, chloroform, and similar agents may cause 
a general anesthesia with unconsciousness. See Anesthetics. 

ANESTHETICS.— Agents which can cause a loss of sensibility (see 
Anesthesia). The introduction of general anesthesia in medicine may be 
accounted one of the greatest of all scientific accomplishments. That it 
should be possible to do the most extensive operations without causing the 
least pain must be looked upon as a technical advance, with which scar cely 
any other, electricity and steam included, can be compared. The agents 
most commonly used are the vapors of ether, chloroform and laughing-gas. 
These vapors are taken up by the blood through the medium of the respira¬ 
tory organs, and are carried to the brain and spinal cord, where they inhibit 
the action of those particular nerve-cells which together control conscious¬ 
ness. So far as the actions of ether and chloroform are concerned they may 






















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PLATE IV, 


DEEP-LYING STRUCTURES OF CHEST AND ABDOMEN 


(From the front) 


1 . 

Larynx 

18. 

Left jugular vein 

2. 

Right carotid artery 

19. 

Thyroid gland 

3. 

Right innominate artery 

20. 

Trachea 

4. 

Right innominate vein 

21. 

Left innominate vein 

5. 

Superior vena cava 

22. 

Arch of the aorta 

6. 

Right bronchus 

23. 

Left bronchus 

7. 

Esophagus 

24. 

Descending aorta 

8. 

Inferior vena cava 

25. 

Diaphragm 

9. 

Liver 

26. 

Spleen 

10. 

Gall-bladder and bile-duct 

27. 

Stomach 

11. 

Transverse colon 

28. 

Pancreas 

12. 

Duodenum 

29. 

Transverse colon 

13. 

Ascending colon 

30. 

Beginning of jejunum 

14. 

Mesentery of small intestine (cut) 

31. 

Descending colon 

15. 

Caecum 

32. 

Sigmoid flexure 

16. 

End of ileum 

33. 

Rectum 

17. 

Vermiform appendix 

34. 

Bladder 





Plate IV 















133 


THE STANDARD FAMILY PHYSICIAN 


Anesthesia 

Anesthetics 


be compared with the pharmacological action of alcohol, inasmuch as both 
are derivatives of the marsh-gas series and are chemically closely compar¬ 
able with alcohol. The effects are practically the same, the important 
difference being one of time. As ether and alcohol are lighter and more 
readily diffusible, their action is more rapid. The action may be summa¬ 
rized as follows: At first there is a diminution in the functioning of the 
higher faculties, these being, as it were, separated from the rest of the nerv¬ 
ous system and rendered inoperative; then the functions of voluntary 
action disappear; the sensations become dimmed; sight, hearing, touch, 
and taste fade away; the incoming paths of sensations are cut off, and the 
simplest reflexes are diminished or abolished until finally the patient is re¬ 
duced to those reflexes which are of the most fundamental character and 
without the action of which life-processes can not be maintained,—namely 
the breathing and the heart-beat. 

The fact that sensation is suspended during narcosis brings with it cer¬ 
tain risks; thus, mucus cannot be coughed up, nor can vomit be expec¬ 
torated. This endangers respiration, and, although it is necessary for the 
anesthetist to combat these conditions, the patient himself may do much to 
reduce the chances of any trouble taking place. It is well to starve oneself 
for twenty-four hours previous to an operation, and to provide for free 
evacuation of the bowels. This does not produce weakness; on the con¬ 
trary, by completely emptying the stomach and intestines, the respiratory 
activity will not be embarrassed. The life of the narcotized person depends 
on keeping up a regular respiration. The patient must also endeavor to 
overcome the excitement natural to such an occasion, and thus to spare 
the heart; for the increased cardiac activity necessarily brought about by 
such excitement will do more to weaken the individual than is ordinarily 
supposed. There is one important factor in preparing for an operation, 
and that is complete and thorough confidence in the physician who holds 
the patient’s life in his hands for the time being. 

There is no greater reward for the operator than the confidence which 
he sees expressed in the patient’s face as he is about to perform an opera¬ 
tion, and which spurs him as a direct and earnest appeal to his best knowl¬ 
edge and abilities. On the other hand, there is no more valuable asset to 
the person who is about to trust his life to the care of the surgeon than this 
same feeling of composure and confidence in the latter’s abilities. After 
the operation, the extreme nausea may be partially overcome if the patient 
will convince himself by a strong effort of the mind that it will soon pass 
over. Inhaling the fumes of vinegar will afford a great deal of relief. No 
food or drink should be taken during the first few hours. It is well to keep 
as quiet and flat as possible and not to get up when vomiting. The after¬ 
effects of an anesthetic,—headaches, vertigo, and a bad taste in the mouth 
—soon disappear. That more severe disturbances might occur, lasting 



Aneurism 

Anise 


THE STANDARD FAMILY PHYSICIAN 


134 


weeks or months, is an unnecessary source of worry, as these have never 
been definitely substantiated. For local anesthetics see Cocain. 

ANEURISM.—A tumor formed by a circumscribed dilatation of an 
artery, and most commonly developed from the aorta. Where the wall 
of the vessel is normal, it may result from a severe concussion of the chest 
or follow the lifting of a heavy weight. As a rule, however, it is produced 
by the gradual dilatation of some part of the wall of the vessel which offers 
less resistance because of the deposits of lime-salts, of fatty degeneration, 
or of other diseased processes. When an aneurism of the aorta has become 
of large size, it may manifest itself as a pulsating tumor on the anterior 
chest-wall. Coincident with the dilatation, there takes place a gradual 
thinning of the wall of the vessel, and the great and impending danger of 
this condition is therefore a rupture of the sac with fatal hemorrhage. The 
symptoms vary in character, depending on the site of the aneurism; they 
include unilateral paralysis of the vocal cords, pains in the chest which 
often radiate into the left shoulder and arm, sense of thoracic pressure, 
cardiac palpitation, etc. The latter symptoms may often be relieved 
by the application of an ice-bag to the cardiac region. Precautions to 
be observed are similar to those indicated for calcareous degeneration of 
the arteries. The treatment is purely surgical, combined with rest and 
hygiene. 

ANGINA PECTORIS.—See Heart, Diseases of. 

ANGIOMATA.—Morbid formations resulting from abnormally devel¬ 
oped blood-vessels. A number of terms are applied to certain peculiar 
patches in the skin which are present at birth or developed shortly after. 
To the laity they are known most commonly as birthmarks, and ascribed 
to some mental disturbance of the mother which has become thus materially 
impressed on the child. This,' however, is an entirely erroneous impression, 
as these superficial, fiat patches in the skin consist of areas of abnormally 
developed blood-vessels. They vary in color from red to purple or blue, are 
quite flat and superficially situated, and may grow rapidly after birth. The 
color depends almost entirely on the preponderance of either arteries, contain¬ 
ing bright red blood, or of veins, containing the darker, bluish blood. They 
are usually located on the eyelids, lips, nose, forehead, cheeks, neck, or 
back, and vary in size from an area as large as the head of a pin to that 
involving the greater part of the face. They may be surrounded by a circle 
of delicate, tortuous vessels, which radiate from a uniformly red center, or 
they may appear as a slightly elevated, bright red patch in the skin. At 
other times they may extend as a broad, blue surface over the greater por¬ 
tion of the face, causing a considerable degree of disfigurement, often in¬ 
vading in addition the mucous membranes of the lips, the cheeks, and the 
nasal cavity. Pressure with the finger causes a blanching, but the vessels 
immediately fill up again as soon as the pressure is removed. As already 








135 


THE STANDARD FAMILY PHYSICIAN 


Aneurism 

Anise 


noted, the growth at first may be no larger than the head of a pin, but a 
further extension may be very rapid. 

Growing angiomata should be removed at once. With the aid of an 
anesthetic, they may be excised or cauterized with the actual cautery in a 
very satisfactory manner. The sooner parents decide to have the matter 
attended to, the smaller the resulting scar. The large blue angiomata can 
never be entirely removed, and require the most extensive operation. Cau¬ 
terization with acids and other substances is employed very often; but this 
procedure is by no means safe, and the effect as regards the resulting scar 
is usually unfavorable. If left untreated, these birthmarks may some¬ 
times very suddenly become transformed into thick, irregular tumors made 
up of the enlarged blood-vessels. In other instances, they have disap¬ 
peared spontaneously, but this is an exceptional occurrence, and should not 
lead to false hopes in any given case. 

ANILIN-POISONING.—The anilin dyes have become so widespread in 
their use, and so many new drugs have been put on the market which are 
made from anilin, that many cases of poisoning, both acute and chronic, 
have resulted. 

It is important to remember that workers in factories in which anilin 
dyes are widely used may be the victims of chronic poisoning. The symp¬ 
toms, which develop slowly, are eruptions of the skin, increasing paleness, 
and headaches. Trembling in the muscles is very frequent, and patches of 
numbness are found in the arms and body. Blood changes may result with 
the appearance of blood pigments in the urine, disturbances of respiration, 
vertigo, giddiness, and fainting. In the case of acute poisoning, which may 
follow the swallowing of a large dose of an anilin dye, but more often after 
a dose of the modern headache-powders, the following symptoms have been 
noted: Headache, weakness, vertigo, blue color to the skin, cold clammy 
skin, and difficult respiration. 

The cause of the poisoning in both instances is the formation from the 
anilin compounds of a derivative, paramidophenol, which has a special 
affinity for the hemoglobin of the blood and prevents its ready oxidation, or 
which may disintegrate the coloring-matters of the red blood-cells. Treat¬ 
ment consists in withdrawal of the poison, fresh air, oxygen, artificial stim¬ 
ulation if necessary, or even bleeding and infusion of salt solution. The 
anilin derivatives that are mainly used in medicine are acetanilid (widely 
employed in the manufacture of headache-powders, neuralgic powders, 
menstrual pain powders, etc.), phenacetin, exalgin, lactophenin, methacetin, 
malarin, cosaprin, malakin, citrophen, phenocoll, apolysin, etc.; new ones 
are being made yearly. Only under most exceptional circumstances should 
these drugs be used without medical instructions. 

ANISE.—The fruit of Pimpinella anisum , a member of the parsley 
family ( Umbellijem ), widely grown in the Mediterranean regions and in 








Ankylosis 

Antimony 


THE STANDARD FAMILY PHYSICIAN 


136 


Russia. It contains an active, volatile oil, from which is derived a phenol, 
anethol. Anise is widely employed as an aromatic in intestinal disorders, 
causing a warmth in the stomach, and contraction which brings about the 
expulsion of gases. In children’s colic it has been used for this purpose, 
and it is very frequently combined with other remedies, such as cathartics, 
etc., to avoid griping. Anise furnishes the characteristic odor of certain 
cordials, notably absinth and the Russian kummel. 

ANKYLOSIS.—Stiffness of a joint. Ankylosis of a joint may be either 
a true or a false form of the disease. In true ankylosis the bones forming 
the joint are grown together firmly, and the joint is absolutely immovable. 
In pseudo-ankylosis the ligaments of the joint and the joint-capsule are 
shortened, and the bones and articular cartilage are more or less grown 
together. In false ankylosis there is always some, if only a slight, degree 
of movability. These conditions of the joints are treated by manual 
massage, or with apparatuses and splints. For mild cases massage and 
medico-mechanical treatment suffice. True ankylosis can be treated only 
by operation. 

ANTHEMIS.—The white chamomile so frequently used in folk-medi¬ 
cine. It consists of the dried flower-heads of Anthemis nobilis, a low, 
hairy, perennial plant belonging to the aster family (Composite), extensively 
cultivated in Europe. It contains a volatile oil which gives it its stimulating 
properties. It is frequently employed as a hot infusion, in which form it 
stimulates the heart-action, dilates the blood-vessels, and causes an in¬ 
crease in perspiration and in the flow of urine. It is frequently employed 
in the initial stages of the treatment of influenza, colds, and similar diseases. 
It may also be employed in the treatment of colic in infants; and it is a use¬ 
ful bitter, stimulating the appetite. 

ANTHRAX.—A very dangerous infectious disease transmitted from 
animal (cattle, horses, sheep, pigs, goats, etc.) to man. The disease is 
usually acquired by handling the skin of an animal which has had the dis¬ 
ease. It is caused by a minute bacterium, the Bacillus anthracis , a plant 
not over -g^o of an inc ^ in length. The anthrax bacilli (see Fig. 63) enter 
the body by various channels. From the point of entrance they become 
localized, or are rapidly disseminated throughout the entire body by the blood- 
current, multiplying enormously at the same time. The symptoms of the 
disease vary according to the mode of infection. Wound anthrax (infection 
from small wounds) shows in rapid succession pain, redness, and swelling of 
the affected part of the skin, followed by the formation of a yellowish, bloody 
vesicle which ruptures and changes into a brown, later black, crust. This 
“malignant pustule” is surrounded by an inflamed eminence and a far- 
reaching swelling of the skin, with bluish discoloration. Signs of a general 
infection become manifest at the same time: high, often irregular fever, 
which may be absent in severe cases; headache; pains in the limbs; weak- 





137 


THE STANDARD FAMILY PHYSICIAN 


Ankylosis 

Antimony 


ness; stupor; blue discoloration of the face; difficult breathing; vomiting; 
diarrhea; and hemorrhages in various parts of the body. 

If infection is brought about by inhalation of wool-dust containing 
anthrax spores, as in hat-makers and rag-sorters (hence, rag-sorters disease ), 
symptoms resembling pneumonia occur in the lungs. Anthrax bacilli may 
be conveyed with the food to the stomach and intestine, where they occasion 
great pains in the abdominal region, as well as eructation, vomiting, great 
thirst, coated tongue, distention of the abdomen, and diarrheas. General 
prostration sets in rapidly, accompanied by fever and by disturbances of 
the activities of the heart and lungs. 

Anthrax usually runs so rapid a course that it is possible only at the 
beginning to preserve life by energetic, eventually operative, treatment; by 
this means the patient sometimes recovers, even with a general infection. 
But usually death occurs from loss of strength, rapid lowering of the tem¬ 
perature of the body, and weakness of the heart. Disinfection of the clothes, 
linen, stools, and sputum of the patient is important. See Disinfection. 

The disease is comparatively common in cattle. Serum-therapy for 
cattle is useful. 

ANTIMONY.—A metal which in its pure form is not used to any great 
extent, but which, as the basis of the double salt of antimonium and potas¬ 
sium tartrate, tartar emetic , has an important place in medicine. When 
rubbed on the skin, tartar emetic has an irritating action, causing redness, 
and it acts on the sweat-glands, bringing about a fine, papular eruption not 
unlike the eruption of smallpox. Its continued application may cause 
suppuration and gangrene of the skin. Tartar emetic lias a slight acrid 
taste, and taken internally in very small doses it stimulates the appetite, 
and is capable also of causing slight stimulation of metabolism. In larger 
doses (i. e., of ^ to J grain) it brings about dilatation of the blood¬ 
vessels, causes relaxation of muscular spasms, and profuse perspiration. 
In still larger doses (up to J or i grain) it almost invariably causes nausea 
and vomiting, and great prostration. The larger doses also may cause 
diarrhea with muscular weakness and all signs of collapse, namely, weak, 
and rapid pulse; cold, wet, and clammy extremities; slow, irregular breath¬ 
ing, and more or less rapidly developing signs of unconsciousness; it may 
give rise also to a blue color of the face, convulsions, and death. As large 
doses of antimony are apt to be vomited, fatal poisoning does not often 
occur. 

In medicine the use of tartar emetic has become more or less restricted. 
At one time it was very widely employed for a great variety of purposes, but 
at present it is used almost entirely as an emetic and diaphoretic, and as a 
relaxer of muscular spasms. Its use may be indicated in the acute stages 
of bronchitis and pneumonia; and it has a certain amount of value in the 
treatment of spasmodic croup, although it is doubtful whether there aie 




Antipyrin 

Antiseptic 


THE STANDARD FAMILY PHYSICIAN 


138 


A 


not other and less depressing remedies which can control the muscular 
action equally as well. 

ANTIPYRIN.—A remedy which was introduced into medicine shortly 
after its discovery in 1883. It is a compound related to the alkaloids, and 
was first prepared from one of the anilin products. It has proved a very 
valuable remedy for the treatment of neuralgic pains and for spasmodic 
muscular conditions, as well as for the reduction of temperature. It is 
soluble in water, and has a very pronounced local action, blanching and 
drying the mucous membrane; and on account of this action it is widely 
employed with good effect in the treatment of colds in the nose, chronic 
coryza, and other affections of the nasal mucous membrane. Sprayed into 
the throat it is capable of overcoming the irritation of chronic sore throat, 
and of relieving the tickling and spasm of this type of affection. Taken 
internally in small doses it acts very quickly, causing in a short time a sense 
of quiet and restfulness due to general muscular relaxation. In doses of 
from 2 to 5 grains it causes these symptoms only, but in larger doses may 
bring about a depression of the heart-action and dilatation of the blood¬ 
vessels, leading to perspiration and a feeling of intense weakness and col¬ 
lapse. In still larger doses it may cause death from cardiac weakness. 

In smaller doses antipyrin is very valuable in the treatment of severe 
headaches, and severe menstrual pains; and it is employed also to relieve 
the neuralgic pains of pleurisy, sciatica, tabes dorsalis, tic-douloureux, and 
similar affections. It is highly recommended in the beginning of acute 
affections, such as influenza, where general bodily distress is a prominent 
symptom; and it is also widely employed in conjunction with salicylate of 
soda to overcome the discomfort of acute articular rheumatism. Antipyrin 
is also very useful in conjunction with sleep-producing remedies, especially 
when slight pains are the cause of wakefulness. Taken internally it very 
frequently causes a rash on the skin which may be confused with that of 
scarlatina, measles, or even typhoid; it is therefore advisable not to use it 
if these diseases are suspected to be developing. Its use is not unattended 
with danger, and persons with weak hearts should not order the drug for 
themselves. Indeed this whole class of drugs should never be self-pre¬ 
scribed, but taken only on the order of a physician. 

ANTISEPTIC.—An agent used to diminish the growth of, or to destroy 
septic organisms. A better term is germicide. When it was realized that 
the germ theory of disease was more than a hypothesis, the importance of 
bacteria as disease-producing agents was greatly exaggerated, and the 
efforts made to destroy them, particularly oustide of the body, were very 
much overdone. Now that students of pathology have demonstrated that 




the number of bacteria which are responsible for definite disease-processes 


are comparatively few, and a better knowledge has been gained of the modes 
by which they enter the body, the study of the different agents used 





139 


THE STANDARD FAMILY PHYSICIAN 


Antipyrin 

Antiseptic 


to destroy them has taken on a much more definite and enlightened 
aspect. 

For purposes of medicine it may be said that antiseptics are divided into 
two large groups, those used for the destruction of germs outside the human 
body, and those used for the purpose of diminishing or destroying the germs 
that may be within the body itself. In the former class are included the 
large body of antiseptics used for disinfecting purposes, the most important 
of which are: (i) compounds of carbolic acid; (2) metallic salts, such as 
bichlorid of mercury, copper sulfate, and salts of lead, zinc and alumi¬ 
num; and (3) compounds giving off free chlorin gas, such as Labarraque’s 
solution, chlorinated lime, etc. For the general disinfection of rooms, 
houses, and open spaces gaseous antiseptics or disinfectants are employed, 
the most popular at the present time being formaldehyde gas. 

In the disinfection of human excreta, which is so important in order to 
limit the spread of infectious diseases, such as typhoid fever, diphtheria, 
influenza, and tuberculosis, the use of antiseptics on the various secretions 
of the human body is very widely employed. Here, as in general disin¬ 
fection, the best results are obtained from the carbolic acid series, from 
formaldehyde, and from the chlorin-discharging compounds. It is highly 
important that the feces as well as the urine of patients suffering from 
typhoid fever should be treated with an antiseptic solution; and the sputum 
of the tuberculous, as well as the throat and nasal secretions of the diph¬ 
theritic should be rendered as aseptic as possible. 

The problem of internal antisepsis is not as simple as that which has just 
been considered. Here, again, at least two things should be borne in mind. 
Antisepsis of the intestinal, of the genito-urinary, or of the respiratory tract is 
essentially different from antisepsis of the cells within the body itself. From 
the standpoint of the anatomist, the respiratory, the intestinal, and the genito¬ 
urinary tracts may be technically considered as being outside of the body 
rather than within it. This is especially true for the intestinal; less so, per¬ 
haps, for the genito-urinary and respiratory tracts. Internal medication by 
means of the mouth is particularly efficacious in ridding the body of a num¬ 
ber of micro-organisms which thrive in the intestinal canal, but so far as is 
now known very few of those organisms that can be reached by such means 
are responsible for any definite disease-process. Typhoid fever, for in¬ 
stance, although it manifests itself very largely through changes in the struc¬ 
ture of the intestinal tract, can not be considered a localized disease, but one 
involving the whole body; and attempts made to disinfect the intestinal 
tract with a view to overcoming the typhoid infection aie unscientific and 
impractical. That some intestinal antiseptics may be of much service in 
limiting the amount of intestinal putrefaction and thus contributing to the 
comfort of the patient and aiding in the general treatment, there can be no 
doubt; but that the general disease will be modified thereby is unthinkable. 






Antiseptic 

Appendicitis 


THE STANDARD FAMILY PHYSICIAN 


140 


Much the same point of view may be held with regard to the respiratory 
and genito-urinary tracts. Antiseptic treatment of diseases of their organs 
has been popular in the past, and even now the giving of respiratory anti¬ 
septics is widely practised in the hope of averting the tuberculous process in 
the lung. It has not been demonstrated that it is possible to kill the tubercle- 
bacillus by any such means; and internal administration of creosote or of 
various aromatic oils, or the breathing of vapors charged with antiseptic 
substances, or the use of electrical devices to force medication into the lung 
proper are all ineffective so far as the tubercle-bacillus itself is concerned. 
It is known that much of the discomfort felt by consumptive patients is due, 
not so much to the ravages of the tubercle-bacillus itself as to the hordes 
of accessory parasites; and as has already been stated in regard to the intes¬ 
tinal tract, so here also the use of internal and external medication may 
alleviate in part at least the unpleasant consequences of these contributory 
factors. 

Whether it is possible, in the present state of our knowledge, to say that 
there are any known remedies which can be introduced into the body and 
affect the bacteria, may be left an open question. There is no doubt that 
quinin, taken in sufficiently large doses, is capable of killing the malarial 
parasite which is found in the body; this parasite, however, is not one of 
the bacteria, but belongs to a group of animal organisms occupying a cor¬ 
respondingly low position in the animal scale. There is also sufficient evi¬ 
dence to justify one in saying that mercurial medication has a pronounced 
action on the cause of syphilis. What this cause may be is not yet definitely 
ascertained. Furthermore there are a number of competent observers who 
hold that the use of salicylic acid and its related compounds is more than 
ordinarily efficacious in overcoming some bacterial infections of the joints, 
particularly acute articular rheumatism. 

In intracellular antisepsis the great difficulty is that it is necessary to 
find an agent that can show a selective poisonous action on the intruding 
parasite, and no poisonous action on the cell-protoplasm. Inasmuch as 
the protoplasm of the human cells closely resembles that of many of the 
lower organisms, this problem has difficulties which only the trained ob¬ 
server can appreciate. But it has become more and more evident that 
selective poisons can be found, and the future opens up large promises in 
this interesting field. 

It only remains in this article to mention some of the most widely used 
antiseptics, and to indicate in tabular form some of the general limits of 
their strength. In reading such a scale it should be remembered that the 
antiseptic power of any substance should be interpreted in the most general 
way. Every individual bacterium has its specific resistance, and what is 
true for it at one time may be different at another, so that the expression of 
a tabular summary of this type should be thought of in the general manner 




141 


THE STANDARD FAMILY PHYSICIAN 


Antiseptic 

Appendicitis 


indicated. The following table shows the disinfecting power of commonly 
used antiseptics, by indicating the minimum strength of their solutions 
necessary to permanently prevent the putrefaction of sewer-bacteria. For 
instance, 1:285 for potassium permanganate, indicates that one part of 
potassium permanganate dissolved in 285 times its own volume of water 
has the strength needed for this purpose. 


Acetic Acid. 1:250 

Alum. 1:222 

Aluminum Chlorid. 1:720 

Arsenious Acid. 1:166 

Boric Acid. 1:143 

Bromin. 1:1,666 

Calcium Oxid.. i: 

Chlorinated Lime. 1: 

Chlorin. 1:4,ooo 


Formaldehyde.. . 1:5,ooo 

Hydrogen Peroxid. 1:20,000 

Iron Sulfate. 1:90 

Mercury Bichlorid.. . 1:15,000 

Potassium Permanganate.1 :28s 

Silver Nitrate. 1:12,000 

Sulfuric Acid. 1:800 

Zinc Chlorid. 1:5oo 


ANTITOXINS. —See Immunity. 

ANUS, ARTIFICIAL. —When the patency of the intestinal canal has 
been interfered with by a malignant growth or a kinking of the gut so that 
the intestinal contents can not be discharged through the anus, they will 
necessarily collect above the site of the obstruction. These waste products 
must be gotten rid of, however; and if it is impossible to remove the ob¬ 
struction by operative or other means, an outlet for the feces must be pro¬ 
vided by the production of an artificial anus. In exceptional cases, a natural 
perforation of the gut may take place through the abdominal wall or other 
structures, and relief be thus afforded. Ordinarily, however, it is necessary 
to perform an operation, by which the abdominal wall is incised, and a loop 
of gut sutured into the wound, and then opened. On the timely production 
of such an artificial anus usually depends the success of the operation. 

ANUS, FISSURE OF. —Term referring to a tear of the mucous mem¬ 
brane at the rectal opening. The act of defecation becomes extremely 
painful as the discharge of the feces necessarily stretches the opening and 
so irritates the sore place. The pain does not stop after the stool has been 
passed but often continues for several hours, so that the patients suffer 
greatly from what is apparently an unimportant condition, and their work 
and manner of living may be seriously interfered with. Fissures of the 
anus may often be cured by a very simple procedure, namely, by stretching 
the muscle (the sphincter ani) which closes the anal opening and which as 
the result of the constant irritation is in a condition of almost continuous, 
painful spasm. In undertaking this operation, it is necessary that the 
patient be anesthetized, and it should not be attempted without this aid. 

APHASIA.— See Speech Disturbances. 

APOPLECTIC STROKE.— See Brain, Apoplexy of. 

APPENDICITIS.— Inflammation of the vermiform appendix. At the 
very tip of the caecum, or blind pouch, situated at the beginning of the large 
intestine, there is located an organ which closely resembles in form and size 























Appendicitis 


THE STANDARD FAMILY PHYSICIAN 


142 


an ordinary earthworm and which is known as the vermiform appendix 
(see Fig. 73). Inflammation of this organ is quite frequent, and gives rise 
to the disease known as appendicitis. The appendix is located in the lower 
portion of the abdomen on the right side. Its cavity is in the form of a 
narrow canal and constitutes a favorite site for the deposit of bits of fecal 
matter which may become hardened and form the so-called “fecal concre¬ 
tions” (see Plate XIII., Figs. 3, 4), and also of bacteria of various kinds. 



'-- Bladder 


“-••Spleen 


Large 

intestine 


Small 

~" intestine 


Liver - 


-* Stomach 


Caecum — 

Vermiform — 
appendix 


Fig. 73. Caecum and vermiform appendix, the wall of the abdomen being removed. 


Occasionally foreign bodies, such as fragments of bone and fruit-pits, find 
their way into its lumen, and a warning should therefore be extended against 
accidentally swallowing these. The irritation resulting from the presence 
of this foreign material produces an inflammation of the mucous membrane, 
which becomes red and swollen; and the condition is accompanied by fever, 
pain, and often nausea and vomiting. This is the most frequent and the 
simplest type of inflammation, and also apt to produce the least harm. It 
may come on suddenly in the midst of perfect health, or it may follow some 
indiscretion in diet, or long-continued constipation. If the disease runs an 
uncomplicated course, the initial violent symptoms disappear within three 
or four days. But if the fever remains high and the pulse rapid, then one 
has to deal with complications which are usually serious in character. 









143 


THE STANDARD FAMILY PHYSICIAN 


Appendicitis 


The ordinary type of catarrhal appendicitis may subside under medical 
treatment alone. The patient should remain in bed, on his back, and keep 
as quiet as possible. The diet should be exclusively fluid, milk, and soups* 
small pieces of ice may be swallowed, and an ice-bag kept over the lower 
right portion of the abdomen. The medical treatment aims to relieve the 
pain and keep the intestines quiet, in order that the inflammatory process 
may not extend. After the disappearance of the fever, the patient should 
be kept in bed for at least another eight days under careful diet. Appen¬ 
dicitis belongs to that class of diseases in which recurrences are likely, and 
these are usually worse than the initial attack. 

The second type of this disease is the purulent. This develops from the 
simple form just described, and sometimes on the first day. The sup¬ 
purative process extends from the mucous membrane to the muscular wall 
of the appendix and then rapidly invades the peritoneum, from which re¬ 
sults a circumscribed peritonitis. It is the generalization of the latter 
which causes the great danger in appendicitis. At first the purulent focus 
may not be larger than a hazelnut, and separated from its surroundings by 
newly formed inflammatory adhesions, which prevent the rupture and con¬ 
sequent spreading of the pus through the general peritoneal cavity. The 
more extensive the abscess, and the longer it is present, the greater the dan¬ 
ger of a general peritonitis. It is essential, therefore, to provide as soon as 
possible for an evacuation of this focus of infection. This can be accom¬ 
plished only by the knife of the surgeon, as the absorption or evacuation of 
the pus through the medium of the gut is so rare an occurrence that no 
reliance should be placed thereon. If the rupture of the abscess into the 
free peritoneal cavity occurs, the latter becomes filled with the pus, and 
surgical interference is too late to do much good. For this reason every 
case of appendicitis needs careful watching by the physician from the very 
beginning, as a change for the worse may take place at any time. 

The third form of appendicitis is the gangrenous, and this is the most 
dangerous. Perforation of the gangrenous tip of the appendix may take 
place during the first day of the disease; the patient rapidly gets worse, the 
condition ending fatally within two or three days. The severe symptoms 
which accompany this type of the trouble are continued high fever, severe 
vomiting, marked abdominal distention, coma, etc. 

Unfortunately it is not always possible to determine just what form of 
inflammation is present in the appendix, nor what course the disease will 
take. For these reasons many surgeons claim that every case of appendi¬ 
citis should be operated for at the first evidences of trouble. This extreme 
view, however, is not universally adopted because careful statistics have 
shown that at least 75 per cent, of all patients with appendicitis get well 
after the first attack. Recurrences of the attacks, which may come on 
during succeeding years, make the prognosis for complete cure somewhat 






Appetite 

Arteries 


THE STANDARD FAMILY PHYSICIAN 


144 


more unfavorable, because small foci of pus or adhesions to surrounding 
structures may remain. In such cases, the patient may well be advised to 
have an operation performed during the interval between the attacks when 
neither pain nor fever is present. The operation is then less dangerous 
and the results more certain, especially if the appendix, which is the cause of 
all the trouble is entirely removed. This organ may readily be spared by 
the body as it possesses no known value. 

APPETITE, LOSS OF.—A frequent accompaniment of various digestive 
disturbances, especially of gastric complaints. It depends on a weakened 
or insufficient amount of the digestive fluids, particularly of the hydro¬ 
chloric acid in the stomach. The tongue loses its normal moist appear¬ 
ance; it becomes dry, and is coated with the accumulation of the cells cast 
off from its upper surface. As a general thing the condition of the tongue 
forms a fairly safe indication of the condition of the stomach, but in some 
cases even the most obstinate and serious gastric illness may cause little or 
no change in the appearance of the tongue. Loss of appetite alone does 
not constitute an absolute criterion of the extent or nature of a disease. It 
may be present in very slight digestive disturbances and absent in the most 
serious. In conclusion, attention must be called to the loss of appetite 
which is a purely nervous condition and which may be recognized only with 
the greatest difficulty by the physician. 

APRAXIA.—See Speech Disturbances. 

ARNICA.—The dried flower-heads* and dried roots of Arnica montana , 
a plant native to Europe, grown extensively in Germany and Switzerland, 
and sparingly found cultivated in the United States. It contains an active 
volatile oil which is largely responsible for its physical effects. The prin¬ 
ciple, arnicin , is also described, but is imperfectly known. Applied to the 
skin, arnica causes irritation, and if the application is permitted to continue 
it may cause inflammation of the skin with the formation of blisters. Taken 
internally it stimulates the mucous membrane of the mouth, esophagus, and 
stomach, and may act as a bitter, improving the appetite. It acts like others 
of the volatile oils, causing a reflex stimulation of the heart-beat, dilatation of 
the blood-vessels of the surface of the body, increased flow of perspiration, 
and also increased flow of urine. In large doses it may cause symptoms 
of burning in the mouth and stomach, nausea, vomiting, intense prostra¬ 
tion with dilated pupils and rapid, feeble heart, cold extremities, occa¬ 
sional convulsions, irritation of the kidneys, and death from exhaustion. 
Liniments containing arnica are in wide favor with the laity, but it is highly 
improbable that they have any specific action beyond their mild counter- 
irritant effects. The alcohol in many of these liniments is probably an im¬ 
portant adjunct in explaining the therapeutic results obtained. Arnica 
is too dangerous a drug to be employed to any great extent for internal 
medication. 




145 


THE STANDARD FAMILY PHYSICIAN 


Appetite 

Arteries 


ARSENIC POISONING AND ARSENIC EATERS.— Arsenic-poisoning 
may result from swallowing the white arsenic in the form of rat-poison, or 
from eating the meat of animals which have become poisoned by this means. 
It may also be caused by the ingestion of various colors containing the poi¬ 
son, or by inhalation of dust from substances containing arsenic for coloring 
purposes, as clothes, toys, wall-paper, candles, etc. The effects may come 
on immediately after the material has been swallowed, and consist of severe 
vomiting, cramps in the muscles of the legs, general prostration, uncon¬ 
sciousness, and convulsions, which may end fatally. In place of this a 
chronic poisoning may result, which may also occur from continued inges¬ 
tion of small quantities for a prolonged period. The latter form is seen also 
in persons who are occupied with arsenic preparations, or who live in rooms 
which are papered or painted with materials containing arsenic. An Eng¬ 
lish epidemic of arsenic-poisoning came from beer, in the preparation of 
which arsenic had been carried over into the glucose. 

The chronic type of arsenic-poisoning can be recognized only by the 
physician, and the most marked symptoms are the poor general condition 
and the pale, emaciated appearance of the subjects. Other symptoms are: 
diarrhea; vomiting after meals; large, brown, scaly patches in the face; the 
flexor aspect of the limbs, the palms of the hands, and on the soles of the 
feet; and tremor and paralysis. In some cases the nails and the hair fall 
out. A chronic cold in the head with pufflness beneath the lower eyelids is 
very characteristic. 

In acute poisoning, emetics should be given at once, followed by lime- 
water with milk or the white of eggs. The medicinal antidote to be ad¬ 
ministered by the physician is a mixture of iron (the hydrated ferric oxid) 
and magnesia. In cases of chronic poisoning the source must be removed, 
and for the remaining treatment a physician had best be consulted. 

In certain mountainous districts of Europe, as in Tyrol, there are persons 
in the habit of taking small quantities of arsenic regularly several times a 
week in order to improve their appearance and, as they claim, to enable 
them to bear more readily the fatigue of climbing. The habit is not con¬ 
sidered harmful; yet the sudden cessation of arsenic-eating is followed by 
the appearance of various symptoms of illness. See Poisoning. 

ARTERIES. —The vessels of the body that carry arterial blood, or blood 
after it has left the lungs and become oxygenated. The name signifies “air 
vessels,’’ and was given to these vessels at a time when, because they were 
always observed to be empty, they were thought to be carriers of air, or 
“vital spirits.” For a knowledge of their distribution and structure consult 

the article on The Circulatory System (pp. 60-65). 

ARTERIES, DISEASES OF.— A number of types of disease are found 
in the arteries. The most important are: Arteriosclerosis , due to old age; 
Arteritis , due to infections by micro-organisms, notably syphilis and tuber- 







£» Respiration THE STANDARD FAMILY PHYSICIAN 


146 


culosis; and Aneurism , due to dilatation caused by mechanical defects which 
may depend upon the two former factors. 

Arteriosclerosis is a change in the character of the arteries, and con¬ 
sists in a gradual thickening of their walls, with or without a deposit of 
lime. This disease usually accompanies old age, although occasionally 
found in the young. It interferes with the normal elasticity of the vessels; 
the arteries, especially those of the wrist and temple, present a hard and 
wiry feel to the touch, and their course becomes more or less tortuous, while 
their pulsations may be visible to the eye. The thickening or calcification 
may develop early in life by severe bodily labor, by the excessive use of alco¬ 
hol or tobacco, by a luxurious life without sufficient exercise, by syphilis, 
gout, and obesity, and by a number of other causes. As a result of this con¬ 
dition there often results enlargement of the heart, congestion and impaired 
circulation of blood in the abdominal vessels, and with this, indigestion, 
constipation, and the formation of hemorrhoids, the last-named often ap¬ 
pearing as forerunners of the trouble in the vessels. If, as the consequence 
of such calcification, the circulation in the coronary arteries is interfered 
with, there follows a disturbance of the heart-action, palpitation, vertigo, 
fainting, bronchitis, and, under certain circumstances, marked evidences of 
cardiac weakness. Cerebral hemorrhage may also take place. 

Many of these consequences may be avoided or postponed by timely 
medical treatment. Persons who lead a luxurious life and are inclined to 
obesity, should be advised to take proper and sufficient bodily exercise, and 
to eat and drink in moderation, taking little meat, but plenty of milk, vege¬ 
tables, and starchy foods. Spices, coffee, tea, alcohol, and tobacco should 
be avoided as much as possible, or better yet, entirely prohibited. More¬ 
over, severe bodily and mental exertion and sexual indulgences are also 
harmful to these patients. Cold sponging and rubbing of the upper part 
of the body are to be recommended, but a warning should be given against 
the extremes of heat or cold in bathing. Daily evacuations may be aided 
by taking fresh or dried fruit, enemas, and mild cathartics when necessary. 
For climatic and other cures see Heart, Diseases of. 

Arteritis is an acute affection of the blood-vessels of the body, due to 
infection by micro-organisms. It is an affection seen most commonly in 
the acute articular rheumatic infections, and in typhoid fever. 

Aneurism. —See special article on this disease. 

ARTHRITIS. —An acute or chronic inflammatory reaction in a joint, 
due chiefly to bacterial infection, to altered trophic conditions, or to dis¬ 
turbances in the chemism of the structures of the joint. The arthritides 
due to the bacteria are, principally, acute articular rheumatism (see Rheu¬ 
matism); gonorrheal arthritis (see Gonorrhea); typhoid arthritis, and 
tuberculous arthritis. The arthritis of locomotor ataxia (Charcot joint) is 
thought to be due to trophic disturbances dependent on degeneration of 







147 


THE STANDARD FAMILY 


PHYSICIAN 


Arthritis 

Artificial Respiration 


the peripheral sensory neurones; while the arthritis of Gout (which see) is 
thought to be related in some manner with altered chemism of the body or 
joint-structures. Consult Arthritis Deformans; Joints, Diseases 
of; Neuritis; Rheumatism. 

ARTHRITIS DEFORMANS. —Deforming inflammation of the joints. 
It is still an open question whether this affection is an individual disease, or 
whether it is a variety of chronic articular rheumatism. It is distinguished 
from the latter in that the affected joints, as is implied by the name, are 
“deformed,” considerable growths of the bones changing the form of the 
joints. The deformity is still more intensified in that the muscles surround¬ 
ing the joint become thinner and gradually waste from disuse. Otherwise 
the symptoms of the disease are almost the same (pains and stiffness of the 
joints) as in articular rheumatism which may persist for years. The affec¬ 
tion occurs most frequently in middle-aged and elderly persons, but it has 
also been observed in young people and in children. It has no connection 
whatever with gout. Women are more frequently affected than men. 

The disease begins with pains in the joints, occurring principally during 
exercise, and subsiding during rest, and with disagreeable stiffness of the 
joints, most marked after rest (for instance, after rising in the morning). 
These disturbances are soon followed by a continually increasing restric¬ 
tion of movability, and by a visible alteration of the affected joints. The 
disease involves either one joint only (for instance, the hip-joint) or, as is 
usually the case, several joints (those of the fingers, hands, vertebrae, etc.). 
The disease operates in such a manner that the corresponding joints of both 
halves of the body become affected, although usually the joints of one side 
are more markedly affected than those of the other. The joints of the fin¬ 
gers are most frequently attacked, resulting in a peculiar attitude of the 
hand. The fingers are slightly curved, held obliquely toward the side of 
the little finger, and imbricated; the joints between the fingers and the bones 
of the middle hand are swollen and thickened (see Fig. 74). As the thumb 
remains fairly movable, a great many patients are still able, in spite of the 
stiffness of the fingers, to accomplish finer work with their hands (for in¬ 
stance, writing, and needlework). Similar, but not quite as marked, are 
the changes in other parts of the body. Other morbid disturbances, apart 
from the wasting of the muscles, are not observed. 

Although the affection persists for a long time, the patient should not 
become despondent. There occur cessations, even improvements, and it 
is possible, with proper treatment and good care, to render life endurable 
even in severe cases, and often to achieve satisfactory results. The treat¬ 
ment is, upon the whole, the same as that of chronic articular Rheuma¬ 
tism (which see). 

ARTIFICIAL RESPIRATION. —Respiration produced by mechanical 
means. To perform artificial respiration the tongue should be grasped 





Artificial 

Respiration 


THE STANDARD FAMILY PHYSICIAN 


148 


with a handkerchief or towel, held between the thumb and index-finger, 
and pulled out beyond the line of the teeth. With the other hand pressure 
is made over the abdomen in the notch between the ribs, toward the dia¬ 
phragm, at regular intervals, about 25-30 times to the minute. By means 



Fig. 74 . Position of fingers in advanced rheumatoid arthritis. 


of this alternating compression and relaxation, the lungs are made to con¬ 
tract or expand. If an assistant is present, he should be directed to extend 
both the patient’s arms fully over the head and then to bring them down 
along the chest and press them tightly against the body (see Figs. 75, 76, 



Fig. 75. Sylvester's method for artificial respiration (inspiration). 

77). The elevation must correspond in time with the relaxation of the 
pressure on the abdomen, and the depression of the arms with the com¬ 
pression on the latter (Sylvester’s method). 

Howard’s method is especially valuable in apparent death from drown¬ 
ing. The body of the subject is bared to the waist and the clothes rolled 






149 


Artificial 

Respiration 


THE STANDARD FAMILY PHYSICIAN 


up into a tight bundle which is placed under the stomach of the patient 
who is stretched out prone on the ground (see Fig. 78). The person 
may also be placed over the knee and the head held with the hand as 
shown in Fig. 79. The tongue thus drops forward and pressure on the 



Fig. 76. Sylvester’s method for artificial respiration : i. Raising of the arms (inpiration). 



Fig. 77. Sylvester's method for artificial respiration: 2. Folding the arms (expiration). 

back favors the outflow of the water through the mouth and nose. The 
subject is then placed on his back and the tongue drawn out at the angle of 
the mouth, preferably on the right side, and held there by an assistant who 
may grasp it with a towel held between his index-finger and thumb. The 











& 2 £«si Respiration THE STANDARD FAMILY PHYSICIAN 


150 


bundle of clothes remains under the back so that the region of the stomach 
is directly elevated. The operator then kneels down alongside the patient, 
or assumes a straddling position over the hips (Fig. 80), placing both 
hands on the chest so that the thumbs are directed toward the intercostal 



Fig. 78. Artificial respiration by Howard’s method. 


notch and the palms extend around the lower part of the thorax (Fig. 81). 
In this position the operator exerts on the subject’s chest a steady pressure 
which may be aided by leaning over and resting the weight of the body on 



Fig. 79. Artificial respiration by Howard’s method. 

the hands (Fig. 81). The operator counts to three, then releases the pres¬ 
sure suddenly; again counts to two, and renews the pressure. This must 
be continued until the person breathes without artificial aid. 

Artificial respiration is useful in the treatment of many poisoning acci- 







151 


THE STANDARD FAMILY PHYSICIAN isafetidl Respiration 

dents, as by opium, morphin, alcohol, coal-tar products (headache- and 
menstruation-powders), etc. It is imperative in the treatment of drowning. 
See Asphyxia; Drowning. Consult also the paragraph on Respiration 
in Introductory Chapters (pp. 52-53). 

ASAFETIDA. A gum resin obtained from an eastern plant, Ferula 
fetida, and from other closely allied species. Many of the plants which 



Fig. 80. Artificial respiration by Howard’s method. 

yield the gum resin are natives of Persia and some of the Russian provinces, 
Afghanistan, etc. The active principles of asafetida are volatile oils and 
gum resins, ferulic acid being one of the most important constituents. This 
body is closely allied to the volatile oil of cinnamon. Asafetida has a very 
disagreeable taste and odor, and is used largely as an antispasmodic. It 
stimulates the intestines to increased peristaltic action, and is capable of 



Fig. 81. Artificial respiration by Howard’s method. 


expelling wind, and of relieving colic. It is frequently used in the form of 
enemas to expel flatus, and is highly effective. As it stimulates the vaso¬ 
motor system and the sympathetic nervous system throughout the whole 
body, it has been thought of much service in the treatment of depressed 
states of the sympathetic nervous system, notably in hysteria. It is usually 
employed in doses of three to five to ten grains in the form of pill or emulsion. 






















Asarum 

Asthma 


THE STANDARD FAMILY PHYSICIAN 


152 


ASARUM (WILD GINGER). —The root of Asarum Canadense , a very 
widely distributed herb found in the eastern part of the United States and 
Canada. Its active principle is a volatile oil which is very sharp and biting, 
causing a feeling of warmth in the stomach and increasing the appetite. It 
is frequently used in small doses, 15 or 20 grains, as an adjuvant to other 
aromatic bitters. 

ASCITES. —Term applied to the accumulation of free fluid in a serous 
cavity, particularly the abdominal cavity. The cavity is more or less dis¬ 
tended depending on the quantity of fluid present, and when the prone 
position is assumed the flanks are seen to bulge. Where the collection of 
fluid becomes considerable in amount, the skin of the abdomen is smooth, 
shiny, and striated. This condition may be caused by localized peritoneal 
inflammations, acute or chronic; by congestion in the portal circulation 
from hepatic disease (cirrhosis of the liver); or as part of a general ascites 
which appears in the presence of heart or kidney difficulties and various 
chronic illnesses. If the ailment is due to inflammatory processes in the 
peritoneum, there is usually present great pain in the lower portion of the 
abdomen, irregular fever, occasional vomiting, irregular bowel conditions, 
and frequent desire to urinate. The abdomen may also be distended by 
the accumulation of gas in the intestine, by ovarian tumors, etc. A careful 
medical examination is therefore necessary to determine the cause of the 
trouble, and eventually an operation is indicated in most instances in order 
to save life. 

ASCLEPIAS (PLEURISY-ROOT). —The dried root of Asclepias tube- 
rosa, a handsome, orange-colored milkweed growing in sandy soil through¬ 
out the northern portion of North America. Its active principle is thought 
to be a glycosid, asclepiadin, the action of which is similar to that of digi¬ 
talis (which see), although much less pronounced. It is a heart-tonic, a 
diuretic, and a contractor of the blood-vessels; but it has no particular 
value as a remedy for pleurisy, notwithstanding its popular name. Its 
chief use is to increase the flow of urine in some cases of heart-disease. 

ASPHYXIA. —Partial or complete unconsciousness due to an insuffi¬ 
cient supply of oxygen in the blood. The condition may result suddenly, 
as in drawing food into the windpipe (in choking); by being immersed in 
water (in drowning); by pressure on the lungs (in pleurisy); or by insuffi¬ 
cient lung space to oxidize the blood (in simple or tuberculous pneumonia). 
It may result from the taking of large doses of certain drugs, notably those 
that in breaking down in the body liberate paramidophenol; particularly 
acetanilid (found in most headache-powders) and phenacetin. It may 
occur also in acute alcoholism, or acute opium poisoning. It may develop 
as a chronic condition in many heart-diseases, and in poisoning by gas or 
other poisons, notably the anilins. The chief symptoms and treatment are 
described under Drowning, and Poisoning. 



153 


THE STANDARD FAMILY PHYSICIAN 


Asarum 

Asthma 


ASPIDIUM (MALE-FERN).— The dried rhizome of Aspidium Filix- 
mas or of Aspidium marginalis, two ferns more or less widely distributed 
throughout the world. The former is found fairly extensively throughout 
the world; the latter is common to Canada and the United States. The 
active principle is not thoroughly known, filicic acid and several closely 
allied compounds being thought to be the most important constituents. 
The action of aspidium is unique. It has the property of killing tapeworms, 
which it does fairly rapidly and very effectively. The drug is rarely ab¬ 
sorbed, as it has some irritating properties causing mild catharsis, but if 
absorbed, and in comparatively large quantities, symptoms of poisoning 
may develop. The most important of these are convulsions, accompanied 
by intestinal irritation, pain, vomiting, purging, relaxation, etc. An un¬ 
common accompaniment of the poisoning is a more or less permanent partial 
or complete blindness. The drug is used as a rule in the form of an oleo- 
resin in doses of one-half to one teaspoonful. 

ASSIMILATION. —See under Organs of Digestion in Introductory 
Chapters (pp. 53-58). 

ASTHENOPIA. — See Sight, Disturbances of. 

ASTHMA. —A disease characterized by a peculiar form of shortness of 
breath or dyspnoea, and due usually to the sudden contraction of the smaller 
bronchi. The most frequent cause for this contraction of a passage which 
is none too wide at best, is a swelling of the mucous membranes which 
line the interior of the bronchi; in other cases it is brought about by a 
spasmodic contraction of the muscular fibers which encircle the air-passages 
in the lungs. 

Attacks of asthma may be incurred by the sudden aggravation of a 
chronic bronchial catarrh, by a disease in the interior of the nose, or by 
purely nervous influences, such as the odor of violets or burnt coffee. In 
some cases the attack appears without warning; in others it may be pre¬ 
ceded by certain preliminary symptoms, as a general sense of unrest, fre¬ 
quent yawning and sneezing, or peculiar sensations in the regions of the 
stomach and the larynx. The patient may be awakened from a sound 
sleep with a feeling of oppression and shortness of breath. He thinks he 
is suffocating, sits up in bed or rushes around the room gasping for air, 
supports himself with his arms on the edge of the table or the window-sill, 
and even throws open the window in order to get as much fresh air as possi¬ 
ble. Breathing is superficial and accompanied by a loud whistling or 
rasping tone, which is distinctly audible at some distance from the patient. 
The facial expression is the picture of fear and unrest, the skin assumes a 
bluish tinge because the blood is not being oxidized, and a cold sweat breaks 
out over the whole body. In the course of one or two hours the attack 
passes away, during which time a greater or less amount of tough, tenacious 
mucus is expectorated. In some instances the condition may be pro- 







Astringents 
Auditory Nerve 


THE STANDARD FAMILY PHYSICIAN 


154 


longed over several days and even weeks, in which there are alternating 
periods of improvements. 

Persons of from 20 to 40 years of age are ordinarily affected. Whether 
the first attack will remain the only one, or whether it will be repeated at 
stated or irregular intervals, it is impossible to know in advance. If the 
condition is due to disease of the interior of the nose, to swelling of the 
turbinate bones, to polyps, or to chronic catarrhs, correction of the primary 
disease will usually result in a permanent disappearance of the asthma. 
But even in such cases it is well not to place too much faith in an absolute 
cure. 

Sufferers from asthma should provide themselves with, and have con¬ 
stantly on hand, a supply of those remedies which they have found by 
experience to furnish them with relief. Of the numerous remedies which 
have been suggested, the following may be mentioned: mustard in the form 
of a paste applied to the chest; immersion of the hands or the feet in hot 
water; the smoking of cigarettes made from stramonium leaves, sage, or 
tobacco; and inhalation of the fumes of burning paper which is impreg¬ 
nated with a half saturated solution of saltpeter. In severe cases the use 
of more efficient drugs may be necessary, but their administration should 
be left to the discretion of the physician. A great deal of good may be 
obtained also from measures directed to improving the general condition 
of the system, among which hydropathic and climatic cures deserve especial 
consideration. When the asthmatic condition is due to pulmonary emphy¬ 
sema, whereby the lung becomes less resilient than in health, on account of 
the diminished elasticity of the air cells, the contrivance known as “ Ros- 
bach’s Chair” may often be used with success. 

ASTRINGENTS. —Agents that, when locally applied to mucous mem¬ 
branes, have the power of coagulating albumen, of precipitating proteids, 
and of affecting the vessels and secretions. Vegetable and mineral astrin¬ 
gents are widely employed, the former owing their activity to tannic acid. 
The mineral astringents are numerous. The most important are lead 
acetate, copper sulfate, zinc sulfate, silver nitrate, and salts of aluminum 
(alum). The animal extract of the suprarenal glands has an action mark¬ 
edly similar to the astringents on the blood-vessels and secretions. As¬ 
tringents are used mostly to limit excessive production of mucus; and 
they are widely employed in cold in the head, in leucorrhea, and in the 
preparation of gargles for sore throat, etc. 

ATAXIA. —A word generally used to indicate the loss of ability to con¬ 
trol muscular movements. Such inability is very frequently a symptom of 
a number of nervous disorders, both of an acute and of a chronic nature, 
and may even be present in a number of other illnesses; it is not infre¬ 
quently the sign of some forms of poisoning, notably alcoholism, mercurial 
poisoning, etc. 










155 


THE STANDARD FAMILY PHYSICIAN 


Astringents 
Auditory Nerve 


Ataxia may show itself in a great variety of forms. At times it may be 
slight, as is seen in mild trembling and loss of muscular control due to 
weakness occuning as a result of any acute illness. It may be very mild, 
as seen in the staggering gait of the semi-intoxicated man; or it may be 
very profound, as in diseases of the nervous system, more particularly in 
Locomotor Ataxia, in multiple sclerosis, in general paresis, and in 
tumors of the cord or brain, particularly in cerebellar tumors. In these 
more severe giades the ataxia may involve a large number of muscles. 
Not only the lower limbs are impaired, but also the arms are inca¬ 
pable of control. Thus a number of individuals suffering from any of 
these diseases are unable to button their clothing without difficulty; they 
frequently can not walk without a cane; and involvement of the muscles 
of the mouth and tongue causes indistinctness, or even loss of speech. 
The cause of the ataxia is difficult to determine, as muscular coordination 
is a complex process; but in nearly all cases in which profound ataxia is 
observed there is usually either an interference with the sensory portion of 
the nervous arc, or some process that interrupts the passage of continuous 
motor impulses from the brain. 

When coming on gradually, ataxia is almost invariably a very grave 
symptom of some disorder of the nervous system, and expert advice should 
be sought at the time when the earliest signs of the disease appear. 

ATHETOSIS. —An irregular rhythmic movement of the arms, hands, 
or body, usually following an injury to the brain-substance, either in the 
motor cortex, or in the motor conduction paths. It most frequently fol¬ 
lows hemiplegic affections, either as a result of cerebral hemorrhage, throm¬ 
bosis, or embolism. 

ATROPIN. —An alkaloid found in many plants of the Solanacece; prin¬ 
cipally, however, in the belladonna plant, Atropa Belladonna , or deadly 
nightshade. See Belladonna. 

AUDITORY CANAL.— See Ear. 

AUDITORY NERVE. —The eighth cranial nerve is the nerve of hearing, 
and probably functions also as a nerve of the sense of equilibrium. It 
arises from nerve-cells situated in two parts of the internal ear, and from 
which fibers collect to form the vestibular and cochlear branches, which, 
uniting, form the auditory nerve. The vestibular branch originates in the 
nerve-cells of the semicircular canals (see Anatomy of the Ear, in In¬ 
troductory Chapters, pp. 70-72), and is largely concerned with the senses 
of equilibrium and position of the body. The cochlear branch arises from 
the ganglion cells of the organ of Corti, and conveys the sound-impressions 
from the organ to the brain. After uniting, the two branches run in the 
internal meatus of the auditory canal, lying in close contact with the seventh, 
or facial, nerve. The cochlear nerves then enter the medulla, and their 
first auditory neuron ends about cells in the superior olive and trapezium. 







Aura 

Bacteria 


THE STANDARD FAMILY PHYSICIAN 


156 


A continuation of the neurons enters the fillet, and terminates about cells in 
the auditory centers in the second temporal convolution. Any lesion in the 
first neuron causes ordinary deafness, while lesions of the second neuron 
bring about auditory aphasia (see Brain, Diseases of). The vestibular 
branches end in the nuclei of Deiters and Bechterew in the medulla, and 
then pass into the cerebellum. Involvement here causes a form of cere¬ 
bellar ataxia. 

AURA. —A peculiar sense which often precedes an attack of epilepsy. 
It conveys the sensation either of suffocation, of a rushing of blood up 
the body, of prickling and numbing, of a headache, or of dizziness. See 
Epilepsy. 

AURICLES. —See Heart; also The Circulatory System in Intro¬ 
ductory Chapters (pp. 60-65). 

AUSCULTATION. —A method of examining the large body cavities, 
notably those of the chest and abdomen, by judging from the sounds that 
they convey to the ear. Laennec was one of the first physicians to develop 
to any degree of perfection this method of examination, although Hippoc¬ 
rates, the father of Greek medicine (400 b.c.), employed the naked ear. 
The examiner may use either the naked ear over the chest or heart, to deter¬ 
mine the functions, or he may use an instrument by which the sounds may 
be the more readily and forcibly conveyed to his ears. Such instruments 
are known as stethoscopes, phonendoscopes, etc. 

AUTO-INTOXICATION (SELF - POISONING).— A type of poisoning 
which may take place in the body of an animal or a plant as a result of its 
own metabolism. In all plant and animal growths, certain products ap¬ 
pear which, unless modified, would poison the plant or animal. Thus, in 
all plants oxalic acid is formed as a necessary step in the building up of 
starches and sugars. The plant protects itself from poisoning by neutral¬ 
izing this acid with calcium salts, forming insoluble calcium oxalate crys¬ 
tals. The human body protects itself constantly in a variety of similar 
ways. Thus, in the very act of breathing, when the oxygen of the air enters 
the red blood-cells, the carbon dioxid formed by the oxidation in the tissues 
is eliminated, and life is made possible. 

As a result of tissue metabolism many acids (sulfuric, acetic, etc.) are 
formed in the human body; avid these acids, if not neutralized and elimi¬ 
nated, as in the urine, would give rise to poisoning. The liver is a very 
active organ in looking after the necessary oxidations and reductions in the 
human body; and it is largely due to the integrity of this organ that auto¬ 
intoxication does not more readily occur. There are few really well-known 
examples of true auto-intoxication in man; and the countless cases de¬ 
scribed by quacks and charlatans are for the most part pure buncombe. 

Among the diseases that are thought to bear a close relationship to auto¬ 
intoxication are the following: (1) Those caused by the failure of chemical 




157 


THE STANDARD FAMILY PHYSICIAN 


Aura 

Bacteria 


function of some organ, as the pancreas (in bronze diabetes ); the thyroid 
gland (in myxedema; cretinism; exophthalmic goiter [?]); the pituitary body 
(in acromegaly ); and the blood-making organs (in pernicious anemia). 
(2) A second group result from imperfect combustion and elimination. 
Diabetes is an illustration. Gout may be another. (3) Retention of a 
product produced in a true physiological process, as in carbon dioxid poi¬ 
soning in heart affections. (4) Excessive production of poisons, with in¬ 
sufficient neutralizing powers, as in the acid intoxication of diabetes in 
which all the alkalies of the body are utilized to overcome the excessive 
amounts of organic acids formed. Other factors are at work, but those 
enumerated are sufficient to indicate the general subject. Poisoning from 
constipated retention of fecal products is not here concerned. This is 
really a poisoning caused by agents outside of the body. 

AUTOPSY.— The examination of a dead body in order to determine 
more minutely and more accurately the causes of death. The public should 
insist on having autopsies performed on all dead bodies, such examinations 
being of service to the people at large by affording physicians the oppor¬ 
tunities for studying diseases more closely. 

AUTO-SUGGESTION. —See Suggestion. 

B 

BACILLI. —See Bacteria. 

BACTERIA. —Name given to a class of simple plants, the relation of 
which to disease processes has become of immense importance. Bacteria 
are exceedingly minute, one-celled plants, often less than -ysrinr an 
in diameter; they have no green coloring-matter ( chlorophyl ) like higher 
plants, and they grow by a process of splitting. In the plant scale they 
are grouped with fungi, and they belong among the very lowest members, 
being intermediate or transitional algae which have become parasitic. 

With regard to shape, three main groups of bacteria are distinguished: 
(1) Coccacece (spherical forms), micrococcus, diplococcus, streptococcus, 
staphylococcus, and sarcina being the names of the genera; (2) Bacteriacece 
(rod-shaped forms), divided into bacillus (with flagella) and bacterium (with¬ 
out flagella); and (3) Spirilla (spiral forms). Other forms are known, but 
with regard to these a reference to some text-books on the subject may 
suffice (see Migula, System der Bakterien ; Kolle und Wassermann, Hand- 
buch der Pathogenen Mikroorganismen; Muir and Ritchie, Bacteriology). 

The properties that are of prime importance in the bacteria are con¬ 
nected with their life history. In their struggle for existence they have 
elaborated a number of chemical substances (ptomains, toxins, etc.) 
which act as poisons on the human body, destroying it by causing complex 
changes in many of the vital organs. The changes that may be induced 






Balanitis 

Bandages 


THE STANDARD FAMILY PHYSICIAN 


158 


by these bacteria and by their poisons are numerous, and the large subject 
of bacterial pathology can not be here considered; as a rule, however, they 
either cause slight changes in the blood so as to render it incapable of carry¬ 
ing on its functions, or their poisons so affect the nervous centers that they 
can not keep up their activities. 

Most bacteria can not live in the human body and hence play no part 
in disease. Many cause diseases in lower animals; and bacterial diseases of 
plants are responsible for the loss of millions of dollars every year to the 
farmer. Bacteria are essential in the breaking down of organic tissues, 
reducing the complex chemical structures to simple compounds that may 
be used by plants. They are invaluable in thus completing the circle of 
balance between plant and animal life. See Causes of Disease in 
Introductory Chapters (pp. 81-85). 

BALANITIS. —An inflammation of the mucous membrane of the prepuce; 
usually caused by uncleanliness. The secretion ( smegma ) which is normally 
present in this region decomposes if not regularly removed, and thus irritates 
the surface of the glans penis, the groove back of this, and the inner aspect 
of the foreskin. The mucous membrane becomes more or less sore, and 
gives off a thin, foul-smelling, purulent secretion. Bacteria from without 
may also be a factor in producing this condition, or it may be due to sexual 
intercourse. The trouble begins with an intense itching of the affected parts, 
and this is followed by the appearance of the purulent secretion, which 
stains the linen. If neglected, this may lead to swelling of the foreskin and 
bring about a narrowing known as paraphimosis. The condition may be 
complicated by inflammation of the lymphatics and of the nearest glands. 
The disease is very often seen in small boys; and if any inflammation of 
the penis is complained of, this condition should always be suspected. It is 
deserving of especial attention because the irritation produced is often the 
means of inducing masturbation in the affected child. 

The best preventatives against this otherwise harmless disease are ex¬ 
treme cleanliness of the parts, regular washing with the foreskin retracted, 
and the application of a dusting-powder to maintain dryness. If suppuration 
is present, the patient should be kept quiet, and cooling lotions applied; 
if the foreskin can not be easily retracted, cold applications and irrigation 
of the preputial sac with lukewarm water are to be employed. If there is 
persistent contraction of the preputial opening, the physician had better be 
consulted in order to avoid subsequent annoyance and possible confusion 
with other and more important diseases. In the absence of complications, 
the condition itself is of little importance and usually subsides under the 
influence of the simple measures mentioned. Certain practitioners make 
much of a simple case of balanitis, usually telling boys that they have con¬ 
tracted a severe venereal disease. The family physician should always be 
consulted. 








159 


THE STANDARD FAMILY PHYSICIAN 


Balanitis 

Bandag-es 



BALDNESS. —See Hair, Care 


of. 


BALSAM OF PERU.— A balsam 
obtained from the Toluijera Perei¬ 
ra, a handsome, tall tree found in 
tropical countries, and chiefly util¬ 
ized in San Salvador. It contains 
volatile oils and resins, as well as 
compounds of cinnamic and ben¬ 
zoic acids, to which many of its 
properties are due. It is much 
employed externally in the treat¬ 
ment of wounds, indolent ulcers, 
and in suppurative conditions of 
long standing in which stimulation 
of granulation-tissue is important. 

It is of service also in itching con¬ 
ditions of the skin, such as scabies, 
etc. Internally, given well diluted, 
it may be of service in chronic in¬ 
flammations of the mucous mem¬ 
brane of the genito-urinary and res¬ 
piratory tracts. It is rarely given in 
more than five to ten grain doses. 

BALSAM OF TOLU.— A balsam 
obtained from the Toluijera bal- 
samum, a tall tree of Venezuela 
and neighboring countries. It has 
many of the properties of balsam 
of Peru, but being milder and less 
irritating than the latter it is used 
more widely in internal medicine. 

BANDAGES. —Surgery employs 
various kinds of bandages, namely, 
cloth, linen, adhesive plaster, plas¬ 
ter of Paris, and water-glass band¬ 
ages. Skill in making these band¬ 
ages is sooner acquired by practise 
than from illustrations. It is im¬ 
portant for the layman to know 
how to make linen bandages, for 
they are easily applied, and are useful in urgent cases. Illustrations of some 
of these with directions for applying them are therefore given. 


Fig. 82. Various forms of bandages. 






Bandages 
Barber’s Itch 


THE STANDARD FAMILY PHYSICIAN 


160 


Bandage to the eye (Fig. 82, a). A folded cloth to cover the sick eye; 
another bandage drawn across the forehead and tied around the back of 
the head, thus keeping the first cloth in a secure position. 

A split bandage for the nose is illustrated in Fig. 83. The lower ends 
are drawn above the ears, the upper ends below the ears and back to the 
nape of the neck where they are tied together. The same kind of bandage 
for the forehead and head is shown in Fig. 84. 

Sling for the arm (Fig. 82, b). Take an unfolded three-cornered 
cloth; put one corner on the shoulder of the arm which is to be supported, 




Fig. 83. Bandage for the nose. Fig. 84. Bandage for the forehead and head. 

bring the right-hand corner and the center of the cloth under the forearm, 
which is bent at right angles, so that the right corner of the elbow protrudes. 
Now draw the second corner of the cloth up over the forearm; carry it 
across the shoulder of the healthy arm, and tie it together with the other 
corner behind the nape of the neck. 

Bandage for the elbow (Fig. 82, c). The center of a folded cloth is 
placed at the bend of the elbow; one of the ends of the cloth is brought 
around the forearm, the other backward around the upper arm, and both 
are then tied together in front. 

Bandage for the hand (Fig. 82, d). A folded bandage is laid over the 
palm of the hand, brought around over the back of the hand to the wrist 
and tied at the wrist. 

Bandage for the hand and fingers (Fig. 85). A broad, folded cloth is 
laid across the fingers, and both ends are drawn over the back of the hand 














101 


the standard family phasician 


Bandages 
Barber’s Itch 


toward the wrist. The ends are drawn around the wrist and tied. A 
similar bandage for the foot is shown in Fig. 86. 

Bandage for the loins (Fig. 82, e). A folded cloth is laid with its center 
at the back of the upper part of the thigh; the ends are crossed at the groin, 
drawn around the loin, and tied. 

Bandage for the knee (Fig. 82, g). A folded cloth is laid with its center 
on the kneepan; one end is drawn over the leg, and the other end over the 
thigh toward the front, where both ends are tied. 

Bandage for the back of the foot (Fig. 82, / and h). A folded bandage 
is laid with its center on the sole of the foot; both ends are crossed at the 
back of the foot, drawn above the heel and around the leg, and tied in front. 



Fig. 85. Loose bandage lor hand and fingers. Fig. 8b. Loose bandage for the foot. 

Fig. 82 illustrates the proper enveloping of the leg and thigh with a 
bandage. 

BANDY LEGS.—See Bow-Legs. 

BARBER’S ITCH (SYCOSIS). —A condition characterized by the appear¬ 
ance of a number of small, red, inflammatory papules and purulent vesicles, 
each of which is pierced by a hair. If a hair is extracted, the root which 
follows is elongated, grayish in color, and shaped like a sausage. When 
the disease has persisted for some time, a considerable section of the bearded 
portions of the face may become indurated as in chronic eczema, or it may 
be covered with crusts. Scars which are free from hair may also be present. 
The disease pursues an extraordinarily chronic course, and is probably 
caused by a microscopic form of fungus (the Trichophyton). 

The treatment in the early stages is very simple, but should be carried 
out under the direction of the physician. Thorough washing with soap, the 
application of soothing solutions and simple ointments, and the extraction 
of the hair involved, comprise the main features. There are a number of 











Iaths°ind Bathing THE STANDARD FAMILY PHYSICIAN 


162 


other skin diseases which in their external characteristics closely resemble 
sycosis, but which require different modes of treatment. It is important 
to expose the affected area of skin by shaving off the beard, and this should 
be repeated for a few years, as the trouble is very likely to recur. There 
is also a type of non-parasitic barber’s itch, which is difficult to distinguish 
from the parasitic type. 

BARTHOLIN GLANDS. —Structures about as large as a pea, and found 
in the lower portions of the labia majora. Their excretory ducts are so small 
as to be scarcely perceptible, but may be found emptying outside of the 
hymen. They were described by a Danish physician, Kaspar Bartholin 
(1585-1629). Inflammations of the genitals may be communicated to these 
glands through their ducts, and result in the formation of painful swellings 
about as large as an egg, which sometimes suppurate. The treatment in the 
latter case consists of a small incision into the superficially situated collec¬ 
tion of pus. See illustration under Womb. 

BASEDOW’S DISEASE. — See Exophthalmic Goiter. 

BATHS AND BATHING. —From the medical point of view baths and 
bathing may be discussed along a number of lines. Cleanliness, exercise, 
pleasure, medicinal treatment, each or all may be in the mind of the bather. 
If the history of primitive peoples is considered, it would appear that they 
bathed very rarely. “Medicinal sweat baths” were not uncommon, how¬ 
ever. Cleanliness seems to have been a more recent object. The early 
Chinese, Greeks, Romans, and Egyptians often indulged in bathing, and the 
magnificent ruins of Roman baths testify to the lengths to which the idea 
of bathing was carried. The history of bathing, and the early opposition 
of the established Church because of the wantonness carried on in the Roman 
baths, is an extremely interesting phase of history. Cleanliness was far 
from being associated with godliness at one time. 

For exercising and developing the body, bathing in rivers, lakes, and ponds 
is unquestionably one of the best methods. In suitable climates it may be 
practised throughout the year, but in the colder climates bathing in fresh 
water should not be indulged in too late in the season. It is true that many 
water fanatics bathe in the open also in winter, and for this purpose often 
cut a hole in frozen streams; but this custom could not be indulged in by 
every one. If fanatics choose to bathe in frozen rivers, they are welcome to 
do so; but if it is maintained by them that this habit is healthy and recom- 
mendable for all, such a position is hasty and ill-considered, if not foolish. 
Cold water baths in the open should be taken only by healthy, strong in¬ 
dividuals. Children should also be induced early to bathe and to learn 
how to swim. Bathing is not advisable for girls and women while men¬ 
struating, especially if this function is readily disturbed, or if the water is 
particularly cold. Bathing should not be indulged in after a full meal; 
and great caution should be observed that the body does not become chilled, 






163 


THE STANDARD FAMILY PHYSICIAN Bathing 


nor the muscles rigid from overexertion. A quick, dry rub, and brisk exer¬ 
cise aic advisable aftei a bath, particularly if the outside air is below 70° F. 

As remedial measures baths of various kinds arc very often applied. 
The vessels foi their application are of dilferent sizes and shapes according 
to the immediate use to which they are put. Tubs for complete body baths 
aie best placed on the llooi, in which position assistance by another person 
may be most readily extended. Bath-tubs sunk below the level of the floor 
are unpractical. In many establishments, pools are provided, which are 



Fig. 87. Half bath, with douche. 

usually sufficiently large for swimming and meet practically the same in¬ 
dications as are associated with river bathing. One advantage which these 
indoor pools possess is the possibility of bringing the water up to any de¬ 
sired temperature, so that this form of bathing may be indulged in throughout 
the year in temperate climates. The one respect in which they fail when 
compared with the river baths, is the fact that the contained water is neces¬ 
sarily not subjected to continuous changes. The amount of water required 
for an ordinary tub bath is from 40 to 80 gallons. Taken for purposes of 
cleanliness its temperature should be about 95 0 F.; immersion should last 
about ten minutes, and may be followed if desired by a cold douche at 77 0 
F. or less. Massage of the body may also be done in the bath. 

The initial temperature of a cool bath should be about 77 0 F. Cold 














Baths and Bathing THE STANDARD FAMILY PHYSICIAN 


104 


water may be slowly added, the outlet being opened sufficiently to keep the 
water at the same level. The degree to which the temperature is to be 
lowered had best be prescribed by the physician. Baths of this kind are 
given in illness to reduce fever, and for this purpose immersion for 5 to io 



Fig. 88. Body bath. ' 

minutes is sufficient. After the bath, the temperature 01 the patient should 
be taken per rectum. Whenever it reaches 102.2 0 F. (39 0 C.) the bath may 
be repeated. The patient must be lifted from the bed into the tub and back 
into the bed again, and then thoroughly dried. These baths were first 



Fig. 89. Sitz-bath. 


introduced by Dr. Brand in typhoid, but are now used in almost all febrile 
diseases. 

Where there is an accumulation of mucus in the lungs, and also in the 
convulsions of children, a favorite form of bath consists of immersion in 
warm water, during which several pails of colder water are poured over 





165 


THE STANDARD FAMILY PHYSICIAN Baths and Bathing 


the shoulders and the neck. In another variety of bath the patient is 
wrapped up in a large bed-sheet, and then lifted into a tub of cold w r ater, 
the head, however, being kept above water. The patient remains in the 
bath only a few seconds, whereupon he is lifted out and thoroughly dried. 
This is a \cry stimulating procedure, but may be given only to vigorous 
persons. 

In the so-called “half bath” the bather sits in the tub with his legs out¬ 
stretched, the water reaching about to his navel (see Fig. 87); the tem¬ 
perature should be 50° to 70° F. The individual splashes the water over 
the chest with his hands, while an 
attendant pours water from the tub 
over his shoulders and neck. This 
should consume about 3 to 5 minutes, 
at the conclusion of which period 
another pail of somewhat colder 
water may be poured over the chest 
and back. While in the bath, the 
legs may be rubbed, or scrubbed 
with a brush. It is essential that 
the body be thoroughly dried after 
the bath. Where fever is present the 
patient should be put back to bed; 
in other cases a walk may be in¬ 
dulged in. 

In another variety of bath, the 
patient half reclines, half sits, in a 
special form of tub (Fig. 88), neither 
legs nor arms being immersed in the 
water. This bath is useful for dis¬ 
eases of the abdomen and the chest, 
and may be taken either hot or cold, 
as directed by the physician; cold water can readily be poured over the 
abdomen. This form of bath is very efficient in certain intestinal diseases, 
in which case it should be of a temperature of 95 0 F., the colder water 
being poured over the abdomen with a sprinkling pot. This bath should 
consume 3 to 5 minutes. 

For the sitz-bath a special form of tub is provided, the front edge of 
which must be broad so as not to press on the legs (Fig. 89). The water 
reaches to about the navel of the bather. When taken warm, it acts as an 
anodyne, antispasmodic, and sedative. It is indicated in many female com¬ 
plaints, in bladder and sexual diseases in the male, and in the presence 
of hemorrhoids. The time required is from 10 to 15 minutes. Cold sitz- 
baths of short duration (1, 3, or 5 minutes) especially stimulate intestinal 



Pig. 90. Alternating foot-bath. 


















Baths a nd Ealhine: THE STANDARD FAMILY PHYSICIAN 


166 


p---—-- 


m k: xmasku »• ta> •« 




activity, and as they are followed by a congestion in the genital organs 
they have been employed for impotence in men. 

For the foot-bath, a pail or suitable tub is required. It may be taken 
as a warm bath for cleansing purposes; hot, for the purpose of drawing 
away the blood from some other part of the body; or cold, followed by 
rubbing and walking, also for the latter reason. Cold compresses, applied 
to the head during the bath, have a stimulating effect on menstruation. In 

another type of foot-bath, the 
water is allowed to flow over 
the feet as far as the ankles, as 
the patient walks about in the 
tub, for i to 3 minutes* This is 
very effective for relieving the 
congestion of blood in the 
head. It may be conveniently 
taken in any brook. In the 
alternating foot-bath, the pa¬ 
tient immerses his feet in hot 
water for about five minutes, 
and then plunges them for 
10-30 seconds into a pail of 
cold water (Fig. 90). After 
this has been done the feet 
must be thoroughly dried, 
whereupon the person should 
walk about. This serves the 
same purpose as the last- 

Fig. 91. Bath for the hand and the arm. named form of foot-bath. 

A bath for the back of the head is very effective in cases of palpitation, 
dyspnoea, and pollutions. The patient lies on a mattress, beyond the edge 
of which his head projects, the back of the head being immersed for five 
minutes or more in a flat basin of cool water. 

The “bidet” is a form of bath which renders it easier to cleanse the 
external genitals, the person using it occupying a straddling position. The 
water used may be either hot or cold. 

The hand and the arm may be plunged into a suitable contrivance (shown 
in Fig. 91), containing either hot or cold water. This bath is used for 
the purpose of directing the blood away from the head and breast, and 
may thus be employed to assist the foot-bath. The elbow-bath is rarely 
used as its action is much weaker. An alternating bath for the hands is 
similar to that described for the feet. 

For other varieties of baths, and for medicated baths, see Bran-Bath; 
Herb-Bath; Hot-Air Bath; Mustard-Bath; Pine-Needle Bath; 



















167 


THE STANDARD FAMILY PHYSICIAN Baths and Bathing 


Salt-Water Bath, Artificial; Sea-Bath; Shower-Bath; Steam- 
Bath; Sulfur-Bath, Artificial. 

BEARD.—The hair on the cheeks, chin, and upper lip (mustache). The 
growth of the beard, as well as that of hair in other parts, depends on the 
development of these structures from the hair-follicles, which also determine 
the general character and color of the hairs. Form, distribution, length, the 
softness, curliness, and thickness, vary in races or families, just as does the 
color. The appearance of the hirsute growth on the chin, lips, and cheeks 
is an accompaniment of complete sexual development in man. In women 
this condition must be looked upon as a deviation from the feminine type. 
Although considered an ornament in men, it is deemed an ugly feature in 
women. It must be evident that a full beard, unless it is extremely well 
taken care of, interferes with perfect cleanliness; and a person who insists 
upon retaining this growth as an adornment ought to realize that it demands 
his especial care in this respect. The care of the beard includes frequent 
washing with soap (preferably that known as lanolin soap), thorough dry¬ 
ing, and the application of a moderate amount of some simple pomade 
which does not decompose. The ordinary pomades which have lard or 
beef-fat as their basis should be avoided, as they readily become rancid and 
give rise to irritating, fatty acids. Those prepared with a lanolin or vaselin 
base are preferable. 

Excess as well as deficiency of fat interferes with the growth of the hair 
and beard, and moderation in the application of these toilet accessories 
should be exercised. Alcoholic hair-lotions, which may be applied about 
twice a week, serve to remove the fatty materials which have accumulated, 
and also to cleanse the underlying skin. One of the best preparations for 
this purpose is the well-known “Eau de Cologne,” which is to be applied 
with a linen rag, the skin afterward to be rubbed with a dry cloth until 
evaporation is complete. Frequent combing has a cleansing effect, and 
by acting as a massage it stimulates the growth of the hair. One of the best 
.hair tonics is a very thin alcoholic or fatty solution of wax. The various 
adhesive preparations which have been recommended are to be zealously 
avoided, as the rubber which they usually contain readily disintegrates, 
thus affording a good culture medium for bacteria. Frequent singeing of 
the hair is harmful unless the hair has first been thoroughly greased. Other¬ 
wise it tends to make the hair brittle, dry, and liable to split at the ends* 
Whenever the latter condition occurs it is safe to say that the hail is too long, 
and it should be kept cut sufficiently short to prevent this taking place. 
There is no doubt that frequent cutting or shaving will cause the hair to grow 
more thickly, but it does not promote a long growth. The beard should be 
trimmed in such a manner that the lips are left ficc, and straggling hairs 
should be brought back into place by aid of the curling iron. Disinfecting 
remedies containing carbolic acid or corrosive sublimate should never be 




Bed 


TIIE STANDARD FAMILY PHYSICIAN 


108 


used, as they cause the hair to break off. Of all the additions to pomades, 
tannic acid in half per cent, solution is the best. 

A perfectly satisfactory remedy for removing a beard from the face of a 
woman, without producing scars, is not available. It is possible to bring 
about a falling-out of the hair-shafts by the application of mixtures 
containing chlorid of lime, or sulfid of arsenic, but this does not inhibit 
future growth from the unaffected follicle. These radical cures must, 
therefore, be constantly repeated. Moreover, they should be resorted to 
only under medical supervision; otherwise the cauterizing process may 
extend and form deep ulcers. Regular shaving merely stimulates renewed 
growth, and does not prevent the discoloration produced by the ends of 
the hair-shafts remaining in the skin. The systematic extraction of the 
hair with an epilation-forceps is the only reliable, though somewhat painful, 
remedy. Certain physicians have recommended destroying each individual 
hair-follicle by means of a fine platinum wire, which is rendered red-hot 
by the electric current and then plunged into the follicle. The resulting 
scars are too small to be very much in evidence. This method must be 
employed in obstinate cases. Whether the destruction of the hair-follicles 
by means of the X-rays, as observed under other circumstances, can be 
made of practical value, has not yet been made the subject of practical 
tests. 

BED.—In order to refresh both body and mind, man spends about one 
third of his life in sleeping. In order to fulfil the indications demanded of 
it, particular attention should be paid to the bed. It must be comfortable 
in order to furnish complete rest during sleep. The non-activity of the 
muscles during sleep causes the body to generate less heat than during the 
waking hours, and the bed-clothes should therefore contribute a greater 
degree of warmth than the clothing. A bed should not be too soft, as this is 
conducive to malposition of the body and a consequent feeling of stiffness on 
awakening. Nor should it be too warm, as this interferes with evaporation 
and produces overheating of the body, and perspiration. The resting- 
place of a healthy individual should consist of a mattress made of horse¬ 
hair, or a suitable bag stuffed with clean straw. The head should rest low ' 
on a pillow stuffed with horsehair, or with tightly packed feathers. As 
covering, a single blanket will suffice for the summer; a double blanket of 
wool, or a quilt, for the winter. Feather-beds are required by a healthy 
adult only during extremely cold weather in unheated rooms; they may, 
however, be used for children or old people during other times of the year, 
but should never be too thick. 

On retiring, all clothes worn during the day should be removed, and a 
suitable night garment put on. The clothes should be hung up, preferably 
outside of the sleeping-chamber, so that they may be thoroughly aired. The 
head should remain outside of the covers during sleep, so that the fresh air 



169 


TIIE STANDARD FAMILY PHYSICIAN 


Bed 


of the room and not the emanations from the body are inhaled. Lying on 
the side while sleeping is preferable to lying on the back. Bed-curtains 
and draperies should be discarded, as they interfere with the free circulation 
of air. Iron bedsteads with spiral springs and a divided mattress are to be 
preferred to a wooden bedstead with its clumsy spring mattress which is 
difficult to clean, and which also affords numerous hiding-places for vermin. 
The bed must rest on legs, so that sufficient space is provided beneath it 
for the air to reach every part. The bed should be so placed that it is not 
exposed to drafts, and it should be kept away from windows and stoves. 
Neither should it be situated next to a damp wall. Every morning the bed¬ 
clothes should be thoroughly shaken and aired at an open window, and as 
often as possible they should be brought into the open air and exposed to 
the sun. Sheets and other bed-linen should be frequently changed. With 
regard to suggestions as to choice, ventilation, and heating arrangements 
for the bed-chamber, see Dwelling-Places. 

The bed of the sick should stand, if possible, in the middle of the room, 
accessible from both sides; not too near a heated stove, and guarded against 
drafts (but without a canopy!). The bottom of the bed, usually a spring- 
mattress, must be even, and uniformly elastic. Casters under the feet of 
the bed are very useful. The mattress resting upon the springs had best 
consist of three parts; its most suitable stuffing is horsehair, wool, sea¬ 
weed, etc. The middle part, which is most exposed to the pressure of the 
body, should be thicker than the sides; therefore it should have a slightly 
convex (curved) surface without being uneven (no grooves). For patients 
who are not cleanly, it is advisable to replace the middle part of the mattress 
by a sack stuffed with chopped straw. The urine trickles through the latter 
upon a trough placed under the mattress, and from there into a chamber 
(see Fig. 92). Special beds with urinals are constructed and may be used 
if the expense can be borne. 

The mattress should be covered with a linen sheet, which must always 
be scrupulously clean, free from all deposits such as crumbs of food, and 
drawn tight and smooth. 

The latter object is readily 
accomplished if each side 
of the sheet is-grasped by 
some one, and drawn tight. 

If a patient is restless, 
fasten the sheet to the 
mattress with safety-pins. 

Pillows stuffed with feath¬ 
ers must be firmly and well 

filled, so that the head does not sink in too much. Large bolsters may be 
used as supports for the head. The coverings of the bed must not hinder 



Fig. 92. Bed for patients who soil themselves. 











Bed-Sores 

Benzoin 


170 


THE STANDARD FAMILY PHYSICIAN 

evaporation; those stuffed with feathers are very unpractical in comparison 
with woolen or wadded comforters. 

BED-SORES.—Ulcers, generally over the bony prominences of the pelvis 
in the buttock region, and usually due to long-continued pressure, as from . 
lying on the back for protracted intervals. They may result from disease 
of the spinal cord; and they may occur also in the region of the shoulder- 
blades and the heels. When patients are confined to bed for several weeks, 
as in protracted fevers like typhoid, or in some cases of insanity, these bed¬ 
sores are apt to develop unless great cleanliness is insisted upon. To ob¬ 
viate their onset the bed should be carefully prepared; air cushions or water 
cushions should be provided, the patient frequently turned, and the skin 
cared for by alcoholic washes and antiseptic powders, formulas for which 
can be obtained from the physician in attendance. 

BEEF TEA. —See Diet for the Sick; Sick, Nursing of. 

BEER.—A beverage properly prepared by a process of fermentation 
from water, hops, yeast, and malted barley. In some beers malted wheat 
is used; from others, hops are omitted; and still in others (as in Bohe¬ 
mian beers) a greater proportion of hops than malt is employed. While 
none of these varieties of beer can be considered really harmful, it is certainly 
a disadvantage when, instead of hops and malt, the brewer employs tansy, 
picric acid, glycerin, quassia, sugar, sirup, etc., as substitutes for the essen¬ 
tial ingredients. In Germany, the superior quality of the Bavarian beers 
is due to the stringent regulations which have long been in force as to the 
purity of the ingredients, and for this reason these beers are among the 
most highly prized in the market. The nutrient value of even these varieties 
is very slight, however, a quart being scarcely the equivalent in food value 
of a single slice of bread. It is a great mistake, therefore, to look upon beer 
as a food; nor should one delude oneself with the idea that several glasses 
of beer daily may be taken without detriment. 

The ordinary varieties of beer have the following composition: 



Carbonic 
Acid Gas 

Alcohol 

Extracts 

Sugars 

Albumin 

Light beers. 

O 

M 

'O 

3-4 

4-59 

4.0 

0 . 8 

Pilsener. 

■ • • • 

3-5 

4-97 

• • • • 

0 • 37 

Miinchener. 

• • • • 

3-7 

5-8 

• • • • 


Porter... 

• • • • 

5 

7.6 

• • • • 

• • • » 

Ale....,... 

.... 

5 -o 

6.0 

• • • • 

• * * * 


The ingestion of a quart of beer, therefore, means the absorption by the 
system of about 30 grams of absolute alcohol; the same quantity of whisky 
would contain approximately about 400 to 500 grams. The difference be¬ 
tween a whisky drinker and a habitual beer drinker is not a very great 
one; and the liability to injure the health by such habits is a serious one 



























171 


THE STANDARD FAMILY PHYSICIAN 


Bed-Sores 

Benzoin 


(see Alcoholism). By the process of Pasteurizing the temperature of the 
beer is raised to 70° C. (158° F.), which destroys the organisms of fermenta¬ 
tion and renders it possible to transport beers a great distance. An increased 
quantity of alcohol needs therefore not be added for this purpose. Beer 
should be stored for a considerable period and be mature and clear, new 
beer being more apt to cause intestinal catarrh. Beer which has been allowed 
to ferment beyond the normal degree, the so-called “weiss bier,” contains 
so much carbonic-acid gas that harmful results from its use may follow; 
and it should therefore be taken in moderation for a twofold reason. 

BELLADONNA-POISONING. —The blackish-red, cherry-like berries of 
the deadly nightshade (Plate XXIII. Fig. 7) have a sweet taste, but instead 
of one large seed they have many small seeds. They may be eaten by acci¬ 
dent, having been mistaken for huckleberries and mixed with them. Chil¬ 
dren have been poisoned from eating only 3 or 4 berries. Nausea and 
vomiting generally occur directly after swallowing the berries. This is 
followed by a burning sensation in the back of the mouth, dryness of the 
throat, and difficulty in swallowing. The most important symptoms are: 
dilatation of the pupils, impaired vision bordering on total blindness, 
scarlet color of the face and body, and agitation. The patient swings his 
arms violently, bites, laughs, screams, and whistles. At times there is no 
agitation, but in its stead profound unconsciousness, resembling a fainting 
spell. Emetics, ice poultices on the head, and enemas of vinegar may be 
given until the arrival of the physician. 

Occasionally the medicinal preparations of belladonna are taken by 
accident. The symptoms are as described, and the remedies employed the 
same. As belladonna causes a loss of sensation in mucous membranes, it is 
better to wash out the stomach than to wait for an emetic to act. A soft 
rubber tube is all that is necessary to do this. Tablets containing atropin, 
the poisonous alkaloid of belladonna, are very widely used for colds in the 
head; and poisoning from them occurs very frequently. The symptoms 
and treatment of poisoning by these tablets are as already outlined. Hot 
coffee is a useful stimulant to be given while waiting for further medical aid. 

BENZIN.— A volatile liquid derived from petroleum. It is used to a 
limited extent in the treatment of parasitic diseases of the skin, and occasion¬ 
ally it has been employed for the purpose of local anesthesia. It has been 
swallowed by accident which has resulted in symptoms of poisoning: nausea, 
vomiting, headache, intense pain, dizziness, increased emotionality, often¬ 
times accompanied with laughing and crying, rapid heart action, inability 
to get the breath, and collapse. The only available method of tieatment 

is to evacuate the contents of the stomach. 

BENZOIN.— A balsam obtained from Sty rax benzoin and other unknown 
species of Styrax, natives of the East-Indian Islands. The active principles 
are benzoic and cinnamic acids and various esters and alcohols. Besides 





Beriberi 

Bile 


TIIE STANDARD FAMILY PHYSICIAN 


172 


being extensively used in perfumery, benzoin is employed in medicine as 
a stimulating expectorant, being of service in the earlier stages of cold in 
the head, loss of voice, and mild bronchitis. When combined in the pro¬ 
portion of one part to ten of water, or an appropriate salve, it is useful 
in the treatment of cracked lip, cracked nipple, a rough complexion, etc. 

BERIBERI.—A form of neuritis, possibly infectious in nature. See 
Neuritis. 

BEVERAGES.—Water forms approximately 60 per cent, of the weight 
of the animal body. The different structures of the body vary somewhat 
in their water contents, as follows: Bones, 22 per cent.; liver, 69; muscles 
(flesh), 75; and kidneys, 82 per cent. These figures clearly demonstrate 
the great importance of water to health. Man is much less able to do 
without drinking than without eating. He can live only a few minutes 
without air, a few days without water, but several weeks without solid food. 

The list of beverages is headed by water, which is best when it remains 
uniformly clear and colorless, even upon standing for some length of time; 
when it is without odor and without taste, and uncontaminated with animal 
refuse. It may without detriment contain moderate amounts of carbonated 
lime-salts. Water taken between meals promotes the appetite, and favors 
digestion, whereas the latter is retarded by alcoholic drinks. Care should 
be taken not to swallow large quantities of water. Excessive heat and great 
cold should also be avoided. The ideal temperature for beverages is between 
50° and 66° F. German medical authors for the most part insist that these 
limits be not exceeded; but it is highly improbable that a moderate indul¬ 
gence in drinks of either higher or lower grades of temperature is particu¬ 
larly harmful. 

Water taken in combination with the juices of fruits, in the form of 
lemonade, orangeade, etc., is a very refreshing and agreeable beverage, 
which neither the wanderer when walking, nor the farmer during his work, 
nor the soldier when marching, need deny himself, even if the drink is 
cooled to a low temperature. Neither does it harm a heated person when 
resting, provided he is careful to drink slowly and in small drafts. Simi¬ 
larly, water in the form of hot soup or hot tea will on cold days warm the 
chilled body more rapidly and more lastingly than if alcohol is added. 
When alcohol is taken, the warming is merely an apparent one, and a de¬ 
pression of temperature will follow its use. See Water and Drinking 
of Water. 

BICYCLING.—A useful form of exercise which, however, is very apt to 
be carried to excess. For medical reasons, bicycle racing should be dis¬ 
couraged, while ordinary riding and fancy riding may be recommended. 
Bicycling may be practised to a moderate degree up to an advanced age 
(60 years and over) if the person doing so is used to it for many years. But 
individuals of more than 50 years of age should generally be dissuaded from 





173 


THE STANDARD FAMILY PHYSICIAN 


Beriberi 

Bile 


taking up this form of exercise, and those over 40 years of age should begin 
it only in case they have been previously accustomed to other regular, 
bodily exercises. Since children up to the fourteenth year of life have a 
great tendency to enlargement of the heart, and since bicycling more than 
many other exercises of the body makes special demands upon this organ, 
the practise of the same should generally not be begun until after this 
period. The question whether girls and women may ride the bicycle has long 
since been decided in the affirmative. Patients suffering from mild degrees 
of affections of the heart and lungs may also, after previous consultation 
with their physician, practise bicycling. If practised rationally, it often 
exerts a favorable influence upon the organs of the abdomen. This is fre¬ 
quently experienced by women suffering from abdominal affections. It is 
obvious that here, too, a previous consultation with the family physician is 
necessary. Fancy bicycling is practised very little. This is the more to 
be regretted as it is a very suitable exercise for the body, owing to its many- 
sidedness. Since bicycling generally causes profuse perspiration, it is nec¬ 
essary to wear good woolen or cotton undergarments, and to protect the 
body from catching cold by completely closing the outer clothes when rest¬ 
ing. Alcoholic drinks should not be used before nor during bicycling. 

If bicycling gives rise to morbid disturbances, such as palpitation of the 
heart, vertigo, peculiar pressure sensations in the head, or even loss of appe¬ 
tite, it must be given up entirely. In recent years a peculiar form of nervous 
disturbances in cyclists has been observed. This must be ascribed not only 
to an excess of cycling, but also to the fact that not every one is fit for this 
one-sided exercise of the body. If a cyclist observes difficulties in voiding 
the urine, a frequent occurrence in more advanced years, he should consult 
a physician. This affection is often associated with an enlargement of the 
prostate gland, and demands suspension of bicycling. It appears that the 
pressure of an unsuitable saddle upon the perineum favors the development 
of this affection. It is important, therefore, to pay attention to the character 
of the bicycle saddle. 

BILE. —The most characteristic secretion of the liver. It is elaborated 
mostly from the blood through the agency of the liver-cells, is collected into 
the hepatic duct from the biliary ducts, and is ultimately discharged into 
the upper end of the small intestine just below the opening of the stomach 
into the duodenum. The gall-bladder serves as a storage reservoir of bile, 
the secretions being conveyed from that gland to the common duct by means 
of a special channel, the cystic duct (see Liver in Introductory Chap¬ 
ters). The bile is at first a light-colored thin liquid, but in the gall-bladder 
it becomes darker and heavier from admixture of mucus, and fiom oxida 
tion; and as ordinarily discharged into the intestines it is greenish to yel¬ 
lowish, becoming darker as oxidation progresses. Thus diarrheal stools 
may be greenish or light yellow because of the presence of partly oxidized 



Biack-wXr Fever THE STANDARD FAMILY PHYSICIAN 


174 


bile. Chemically, bile is an alkaline fluid with a bitter taste, containing 
much water, alkaline salts, coloring-matters (bilirubin; biliverdin), fat, 
cholesterin, bile acids (glycocholic and taurocholic), lecithin, and soaps. 

The uses of the bile are various. It aids in elimination, many poisonous, 
broken-down products being thrown off from the body through the bile; 
it aids in the digestion of fats by assisting in their saponification; it prob¬ 
ably plays an antiseptic role, thus keeping down the number of intestinal 
bacteria; and it is an important factor in regulating the normal movements 
of the fecal contents of the intestines, constipation being almost invariably 
a concomitant of diminished bile production or elimination. The bile has 
undoubtedly other functions, but they are but little understood. Under 
certain circumstances, as yet not fully determined, the salts of the bile, or 
the cholesterin, precipitate and gall-stones are formed. These often give 
rise to serious attacks of pain, and often their presence jeopardizes the life 
of the patient. See Gall-Stones. 

BILIOUSNESS.—A form of self-poisoning or auto-intoxication usually 
due to defective intestinal functions rather than to any affection of the liver 
itself. The usual onset of an attack is preceded by an uncertain amount of 
indigestion due to a mild catarrhal inflammation of the stomach and duo¬ 
denum. This mild grade of inflammation causes the mucous membranes 
to become somewhat thickened, thus narrowing the common duct, and 
diminishing the amount of bile that may pass into the intestines. The in¬ 
flammation, together with the absence of the bile, permit of an excessive 
amount of intestinal putrefaction and fermentation, and as a result head¬ 
ache, perhaps nausea and vomiting, constipation, general misery, clayey 
stools, dark urine, and slight jaundice develop in milder or severer forms. 
Alcoholic drinks, excessive eating, particularly of foods rich in fat, lack of 
exercise, etc., are often the causes of the initial intestinal disturbances. The 
treatment should consist in large part of restriction in diet (sometimes an 
absolute water diet is necessary), mild catharsis by a non-irritating cathar¬ 
tic, and hot-water enemas. See Bile; Constipation; Liver, Diseases of. 

BIRCH.—The bark and leaves of Betula lenta. Birch bark and leaves 
contain an active volatile oil very closely resembling oil of wintergreen, and 
consisting largely of pure methyl salicylate. This substance has the action 
of the salicylates in general, being particularly useful in acute articular 
rheumatism, either applied locally or taken internally. See Salicylic Acid. 

BIRTH.—See Parturition. 

BIRTHMARKS.—Yellow or brownish-black, round or oval, raised, 
sometimes hairy or warty marks on the skin; and sometimes supplied with 
a stalk. Generally they consist of congenital deposits of pigment in a 
morbidly changed portion of the skin, or of collections of densely interwoven 
blood-vessels (naevi). They are not due, as is so frequently held, to “taking 
fright during pregnancy,” nor to the “sins of one’s ancestors,” etc. They 





175 


THE STANDARD FAMILY PHYSICIAN ggSSSffir Fever 


are related either to warts or to strawberry-marks (port-wine stains); and 
they can be removed only by operation. 

BIRTH, PREMATURE. — See Abortion. 

BISMUTH SALTS. —The soluble salts of bismuth are all too poisonous 
to be utilized in practical medicine. The insoluble salts, however, are 
widely employed as intestinal antiseptics, and as anti-fermentatives in affec¬ 
tions of the stomach and intestines. The salts of bismuth most in use for 
this purpose are bismuth salicylate, bismuth subcarbonate, bismuth sub- 
gallate, and bismuth subnitrate. These are used in comparatively large 
doses (15 grains up), especially the more insoluble ones, such as the sub¬ 
carbonate and subnitrate. There are a large number of other bismuth 
compounds known, but those mentioned are the only ones in extensive use. 

BITTERS. —Substances which by their action on the nerves of taste in¬ 
crease the sense of appetite and also stimulate the muscular mechanism of 
the stomach. Most of the bitters of the market are alcoholic drinks, thinly 
disguised by the addition of some plant bitter. Some of them are as strong 
as whisky; most of them are stronger than strong wines. Aromatic and 
simple bitters are recognized in medicine, the former containing, in addition 
to the bitter principle, an aromatic volatile oil. Simple bitters are quassia, 
gentian, chiretta, calumba, and nux vomica. Aromatic bitters are wild 
cherry, hoarhound, cascarilla, angostura, serpentaria, chamomile, etc. 

BLACK DEATH. —See Plague. 

BLACKHEADS. —Small swellings in the skin, due to obstruction of the 
openings of the sebaceous glands. The most superficial part of the extru¬ 
ding fatty matter dries and turns black (hence, blackhead). Actual exuda¬ 
tions of sebaceous masses of the glands of the skin take place, and can be 
brought out by pressure between two finger-nails or a watch key, the exu¬ 
ding matter creating the impression of a whitish worm. The sebaceous 
plugs, which greatly disfigure the skin, often develop simultaneously with an 
overproduction of a glistening tallow of the skin ( steawhea ) about the nose, 
lips, and forehead. By destruction of entire sebaceous glands, they lead 
to blotches, to the formation of furuncles, and to various eminences of the 
skin. 

The principal preventive is scrupulous cleanliness, frequent bathing, 
massage, the use of sulfur soaps, and the addition of tai and wax-paste to 
the soap. Benzin is an excellent and harmless remedy to dissolve the plugs, 
and serves to facilitate the squeezing (also with a watch-key), and also as 
a means for the removal of the outflowing skin-fats. Constipated habits 

should be overcome. 

BLACK-WATER FEVER.— A disease thought to be a severe type of 
malaria. It is observed in various bad malarial legions, but chiefly on the 
coast of tropical Africa; and it is characterized by fever, gencially ushered 
in by a severe chill, serious constitutional symptoms, \omiting, jaundice, 





Bladder 


THE STANDARD FAMILY PHYSICIAN 


176 


and a peculiar discoloration of the urine, due to the sudden destruction of 
a large number of red blood-cells. This last characteristic, being the most 
striking to the lay mind, has given the name to the disease. The urine may 
have a bordeaux-red color, or resemble coffee, porter, or Malaga wine, or 
may even become blackish-brown owing to the copious admixture of the 
coloring-matter of the blood. The disease lasts from a few days to a 
number of weeks. It rapidly produces severe anemia and loss of strength, 
and often has a fatal outcome. 

Black-water fever occurs as a rule in persons who have spent a con¬ 
siderable period of time in a malarial region, and who have perhaps already 
passed through several attacks of malaria. It is rarely observed within the 
first six months of a sojourn. Among the incidental causes, quinin seems to 
play an important role. The attack often follows immediately upon the 
use of the drug, at times even upon the taking of a very small dose. The 
quinolin derivatives, of which quinin is one, have the power of causing 
blood changes; and it may be that the extra stress put on the blood by even 
small doses of quinin aid in the hemolysis. It is essential to summon a 
physician as soon as possible, a desideratum often difficult to fulfil in the 
tropical regions in which the fever is endemic. The patient must forego 
the use of quinin; and the suppression of urine which ordinarily occurs in 
the disease must be combated by the absorption of large amounts of fluids, 
especially mineral waters and milk. The prophylactic measures are iden¬ 
tical with those for malaria. It may be that this disease is due to a micro¬ 
organism allied to, yet distinct from, that of true malaria. 

BLADDER. — For structure and functions, see Urinary Organs in 
Introductory Chapters (pp. 58-59). 

BLADDER, DISEASES OF. —Under this general heading will be de¬ 
scribed some of the more common affections of the bladder. 

Cystitis. —Inflammation of the bladder, or vesical catarrh, may vary 
greatly in its manifestations, and may be due to any one of many causes. 
Retention of urine, and injuries, however slight, to the mucous mem¬ 
brane lining the bladder, seem to be important factors. Mechanical, 
infectious, or chemical influences also play a part in the production of the 
further development of the disease. The most important causes may be 
summarized as follows: abrasion of the mucous membrane, and infection 
of the interior of the bladder by instruments introduced for various purposes; 
bacteria which find their way from without on instruments, from within 
by transmission from the ureters, the pelvis of the kidney, and the large 
intestine; foreign bodies, gravel and stones, which have been formed in the 
bladder or in some portion of the urinary tract higher up; narrowing of the 
caliber of the urethra; obstruction to the regular passage of the urine by 
enlargement of the prostate due to advanced years; acute and chronic 
gonorrheas; tuberculosis of the bladder; chemical irritants, such as acrid 



177 


THE STANDARD FAMILY PHYSICIAN 


Bladder 


remedies used for washing the bladder, and the administration of drugs 
like cantharides (Spanish fly); and, finally, the not generally acknowledged 
influence of exposure. As regards the last-named, there is no doubt that a 
cold aggravates an already existing catarrh of the bladder. 

In an acute attack of vesical catarrh the symptoms consist in a frequent 
desire to urinate, and the passing of urine rendered cloudy by the admix¬ 
ture of pus and mucus, and occasionally bloody. The blood is usually 
noticed with the last drops of the urine, which is scanty in amount but 
frequently voided. Fever and a moderate degree of constitutional dis¬ 
turbance are often present. The greatest annoyance, however, is caused 
by the constant desire to urinate, which also interferes with proper sleep. 
The chronic catarrhs are accompanied by fewer general disturbances; but 
the local symptoms, the urinary changes, are more marked, and the disa¬ 
greeable odor due to the decomposition of the urine is a source of continual 
annoyance. 

The main indications for treatment must be prescribed by the physician 
after the exciting causes have been determined. It should be borne in 
mind, however, that in addition to the necessary medical and instrumental 
treatment, every case of vesical catarrh demands proper attention on the 
part of the patient. Rest in bed is to be recommended as a safe way of 
avoiding cold, and also for the maintenance of uniform bodily warmth. 
Warm sitz-baths and full baths are useful, especially where there is diffi¬ 
culty in passing urine. Alcoholic drinks and richly seasoned dishes had best 
be entirely avoided; and attention should be given to the daily emptying of 
the bowels. It is well to abstain from taking natural or artificial mineral 
waters which contain much carbonic-acid gas. In the presence of chronic 
catarrhs, it is important to avoid the dangers attendant upon self-catheter¬ 
ization, by following closely the directions for the cleansing of instruments 
employed for this purpose (see Catheterism). 

Hemorrhage from the Bladder. —A condition which may appear as one 
of the symptoms of catarrh, of stones (especially after violent exertions), or 
of tumors or injuries of the bladder, the latter particularly if the hip be frac¬ 
tured. Before any final decision can be reached in regard to the cause of 
the bleeding, whether it is derived from the bladder itself or from the upper 
portion of the urethra, a careful chemical and microscopical examination of 
the urine is necessary, supplemented in certain cases by an examination of 
the interior of the bladder by the aid of artificial light. Where severe spas¬ 
modic cramp in the bladder is present, there is in all probability a catairh; 
when there is marked pain after urinating, a stone is very likely present, 
and when hemorrhage appears without other known cause, a tumor of the 
bladder probably exists. In every case of hemorrhage from the bladder, 
even in that following injury, complete rest must be enjoined until the 
arrival of the physician; and where injury has taken place, an ice-bag is 




Bladder 


THE STANDARD FAMILY PHYSICIAN 


178 


to be recommended. Hot-water bags are useful in reducing the pain; or 
cloths wrung out of hot water, and on which a drop of turpentine has been 
placed, may be used. 

Paralysis of the Bladder. —A condition usually accompanying diseases of 
the spinal cord. It may occur also during unconsciousness, or as a result of 
gradual degeneration of the muscles of the bladder from chronic inflamma¬ 
tory processes: catarrh, urethral stricture, and enlargement of the prostate 
gland. The paralysis involves partly the sphincter and partly the expulsive 
muscles, so that the urine either can not be retained in the bladder and is 
constantly dribbling, or can not be properly voided because the expulsive 
power is lost and retention results. The prognosis and the treatment, 
whether palliative, radical, or otherwise, must be left entirely to the discre¬ 
tion of the surgeon. Where there is retention of urine, catheterization will 
probably be found necessary. 

Spasm of the Bladder. —A peculiar disturbance of urination due to some 
irritation of the neck of the bladder, all the causes of which are not as yet 
fully understood. It sometimes follows the use of alcoholic drinks which 
have not been completely fermented; and it is often present in cystitis or 
inflammation of the bladder. The condition is characterized by an intense 
desire to urinate, which persists for some time after the bladder has already 
been emptied. Attempts to pass the urine result in the expulsion of only a 
few drops, and call forth a severe burning pain. The desire soon returns, 
however, and continues for some time until the normal condition is again 
restored. In rare cases the vesical spasm, which may vary from a dribbling 
of the urine to complete retention, is the result of nervous disturbances; 
and this form naturally demands medical attention. The other type is 
usually transitory, and may be satisfactorily combated by the plentiful 
administration of warm drinks or alkaline waters, the use of bicarbonate of 
soda, and a hot sitz- or a warm body bath. Persons who are liable to this 
otherwise harmless form of vesical spasms, should avoid the use of incom¬ 
pletely fermented beverages. A similar train of symptoms may also be 
present at the onset or during the course of an acute catarrh of the bladder, 
or when there are stones or foreign bodies in the bladder. The immediate 
cause in any given case must be carefully determined by the physician in 
attendance. 

Stones in the Bladder. —Bladder-stones, or calculi, are found in adults 
and children, but are more often observed in men than in women. The 
chemical composition varies widely, and a number of substances may be 
present. The color, size, form, and hardness are also subject to wide 
variation. Urates, phosphates, and oxalates of the alkalies, sodium, and 
potassium, are the most frequent components (see Plate XIII., Fig. i, a , 
b , c ). Calculi are commonly formed about some particle of gravelly ma¬ 
terial, which finds its way from the pelvis of the kidney and becomes enlarged 




179 


THE STANDARD FAMILY PHYSICIAN 


Bladder 


in the bladder by the deposit of the substances enumerated. Foreign bodies 
which have entered the bladder may also serve as a focus of accretion. 
The chemical composition of these stones has little to do with the symptoms 
which they produce. A calculus may remain in the bladder for a consid¬ 
erable period of time before the patient becomes aware of its presence. In 
fact, many patients may never know they have a stone in the bladder. As 
a rule no pain is felt until the stone, by constant rubbing, has produced an 
injury to the lining mucous membrane of the bladder, usually near the neck. 
The pain is ordinarily felt radiating out toward the glans penis at the com¬ 
pletion of urination. Violent movements, such as riding, jumping, dancing, 
fighting, etc., may bring about a hemorrhage from the bladder. Some¬ 
times there is sudden stoppage of the urinary stream, the normal course of 
which is resumed after the patient makes some characteristic movements. 
The patient at this time may experience a feeling of some sudden mechan¬ 
ical obstruction. When a stone has been in the bladder for a considerable 
period of time, a chronic catarrh usually develops. An important point in 
the diagnosis of many cases, is a history of previous attacks of renal colic, 
but in most instances judgment can be passed only after a thorough medical 
examination, including abdominal and rectal palpation, introduction of a 
stone searcher, and perhaps the illumination of the interior of the bladder 
by artificial light. X-ray examinations are also useful in detecting the 
presence of vesical calculi (see Plate XV.). 

Operative interference is ordinarily indicated, for there is no internal 
method of treatment as yet known by means of which a stone may be 
dissolved in the bladder. All that medication may accomplish is the pre¬ 
vention of gravel formation in the kidney, thus doing away with the pro¬ 
duction of one form of focus around which calculi can be deposited when 
this material finds its way into the bladder. On the other hand, internal 
treatment, or a course of waters at some mineral spring, may seem to pro¬ 
duce a beneficial result, because of its good effects on the accompanying 
vesical catarrh. In most cases, a combination of medical and surgical 
treatment, together with a suitable diet, is indicated. The diet depends 
somewhat on the composition of the calculi previously obtained, and this 
knowledge should also influence the selection of an appropriate mineral 
water. Where there is present an increase of uric acid, the patient must 
avoid eating large quantities of meats, sour foods, strong or acid wines and 
beers, and adhere mainly to a diet composed of milk and vegetables. The 
fancied difference between red and white meats is not based on correct 

chemical analysis. 

Among the mineral waters, those from the following springs have been 
recommended: European: Fachingen, Wildungen, Vichy, Carlsbad, and 
Marienbad; American: Saratoga, Alma, Blue Lick Springs, and Mt. 
Clemens. If the calculi are made up of oxalates, the same waters may be 




Bleeding 

Blister 


THE STANDARD FAMILY PHYSICIAN 


180 


taken, and all vegetables containing much calcium oxalate (rhubarb, spin¬ 
ach, etc.) must be avoided. In the presence of phosphatic calculi, acids 
(especially those derived from plant sources) and carbonated waters may be 
recommended. 

Tumors of the Bladder. —New growths in the bladder may be either 
benign or malignant in character. An accurate diagnosis can not as a rule 
be made from the examination of bits of extruded tissue that may be found 
in the urine. It is usually found necessary to illuminate the interior of the 
bladder (cystoscopy), or to expose its cavity by an incision (cystotomy). 
When a hemorrhage takes place from the urethra without any known exci¬ 
ting cause (such as gonorrhea), suspicion should always be directed to the 
presence of a growth in the bladder. During the early stages of their for¬ 
mation, these tumors are not distinguished by any clearly defined symp¬ 
toms. There is present a more or less chronic process, to which urinary 
difficulties and evidences of catarrh are later added. After the diagnosis 

has been confirmed, surgical interference is necessary; and the prognosis, 

/ 

based on the advances in modern technique, is usually very favorable, except 
in those instances where a malignant growth, such as cancer, is found. 
This fact should be constantly borne in mind, as it illustrates the great im¬ 
portance of early operation for these malignant cases. Delay is usually 
fatal. 

BLEEDING. —See Hemophilia; Hemorrhage. 

BLEPHARITIS. —See Eyelids, Diseases of. 

BLIND, ASYLUMS FOR THE. —Aside from the institutions for the 
care of the blind, which are known to have existed in China thousands of 
years ago, the first asylum of this kind was founded in Paris in the year 
1784. Shortly afterward, similar institutions were started in Liverpool, 
Edinburgh, Bristol and London. Asylums were founded in Berlin and in 
St. Petersburg in 1806; in Vienna, 1808; and in Dresden in 1809. At the 
present time almost every civilized country is amply supplied with asylums 
of this character.. As a rule they have been founded by private individuals, 
the state having lent its assistance at a later date. In some countries attend¬ 
ance is obligatory; the children are entered at the age of six, and remain 
under instruction until the eighteenth or twentieth year. After that they 
either follow their own inclinations, or are provided for in special avenues 
of employment connected with the institution. 

In the United States the earliest institution of this kind, the New Eno-- 
land Asylum for the Blind, was founded in 1829 in Boston. It was opened 
in 1832, a few months after the opening of the New York Institution for 
the Blind. In the following year (1833) a school for the blind was opened 
in Philadelphia; and in 1899 there were 40 such schools in the United 
States, a special school for the colored blind having been opened in 1869. 
All the states of the union now make provision for the blind. 




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PLATE V. — BLOOD-VESSELS OF THE CHEST AND ABDOMINAL 




CAVITY 


1 . 

Right common carotid artery 

19. 

Left common carotid artery 

2. 

Right innominate artery 

20. 

Aorta 

3. 

Right subclavian artery 

21. 

Left subclavian artery 

4. 

Superior vena cava 

22. 

Pulmonary artery 

5. 

Right pulmonary veins 

23. 

Left pulmonary veins 

6. 

Right auricle 

24. 

Left auricle 

7. 

Right ventricle 

25. 

Left ventricle 

8. 

Diaphragm 

26. 

Diaphragm 

9. 

Hepatic veins 

27. 

Aorta 

10. 

Right renal artery and vein 

28. 

Celiac axis. Superior mes« 

11. 

Right kidney 

29. 

Left renal artery and vein 

12. 

Inferior vena cava 

30. 

Left kidney 

13. 

Right ureter 

31. 

Aorta 

14. 

Right common iliac artery 

32. 

Inferior mesenteric artery 

15. 

Right internal iliac artery 

33. 

Left common iliac artery 

16. 

Right external iliac artery 

34. 

Sacral artery 

17. 

Rectum 

35. 

Left internal iliac artery 

18/ 

Bladder 

36. 

Left external iliac artery 


0 

37. Left ureter 


* 


Plate V 











181 


THE STANDARD FAMILY PHYSICIAN 


Bleeding 

Blister 


BLINDNESS. —Term referring to the inability of an eye to perceive 
light; practically, however, the designation of “blind” is applied to indi¬ 
viduals whose sight is impaired to such an extent that they can not find 
their way about. In most countries where vaccination is universally em¬ 
ployed, the number of the blind has markedly decreased. Where this 
operation is not compulsory or is not used to any great extent, smallpox 
is the most frequent cause of blindness. At the present time the most 
common cause of blindness among civilized peoples, is the purulent, or 
gonorrheal, conjunctivitis of the new-born. 

Blindness may come on at any time of life, when the transparent parts 
of the eye become impervious to light as the result of extensive corneal 
cloudiness, closure of the pupil from inflammation of the iris, cataract, 
diseases of the retina and choroid, affections of the optic nerve, or severe 
injuries to the eye. Diseases of the brain and spinal cord may also bring 
on blindness. As a general rule, cases of blindness which are congenital, 
or which are due to disease of the retina, the optic nerve, or the brain, must 
. be looked upon as hopeless. Partial blindness is a term applied to that 
condition in which a portion, even one-half of the visual field of one or both 
eyes is affected, so that the patient is blind in spots ( amblyopia) or sees only 
those objects which happen to come on either the right or the left side of 
the median line ( hemianopsia ). Such forms of blindness usually result 
from injury to the nervous elements of the eye. 

The term “psychic blindness” or “mind blindness,” is applied to a con¬ 
dition in which, as the result of destruction of certain portions of the brain, 
the patient can still see, but is unable to interpret what he sees. 

BLISTER. —An effusion of serum underneath the superficial skin. It 
may be brought about by any irritating agent, extreme heat (as in a burn), 
extreme cold (as in freezing), or by a variety of other physical and chem¬ 
ical agents. Thus X-rays, the electric spark, radium, etc., can cause blisters 
on the skin; or they may be produced by such substances as mustard, can- 
tharides, and similar pharmaceutical agents. In medicine, blisters are most 
frequently produced by mustard, cantharides, turpentine, or by the actual 
cautery. The chief action of a blister is as a counter-irritant. Whereas it 
is frequently believed by the laity that such blisters draw the morbid matter 
to the surface, and that thus the cause of an illness is removed, the true 
action is far different. It consists really in setting up a nervous reflex action 
in the sympathetic nervous system. It has been established that practically 
every internal organ of the body has a representation in the superficial 
layer of the skin, and that influences acting on the organs may show 
themselves by changes of greater or less degree of definiteness in these 
superficial, related areas. Conversely, irritations of these areas in their 
turn can bring about modifications in the activity of the organs themselves, 
particularly in the matter of their blood supply. 





Blood 

Blood-Poisoning- 


THE STANDARD FAMILY PHYSICIAN 


182 


In the endeavor thus to modify the internal organs, or parts lying in 
close proximity to the organs, this counter-irritation may be used. Thus, 
in the treatment of pleurisy and pneumonia, counter-irritation is helpful to 
give muscle-tone to the blood-vessels of the lungs and pleura, and it may 
assist in preventing overdistention with resulting paralysis in these blood¬ 
vessels. Counter-irritation is also widely employed to overcome neuralgia. 
Here the counter-irritation is thought to bring about a similar modification 
in the condition of the blood-vessels of the nerve-trunks; and the goodeffects 
that follow application of the actual cautery, or of fly-blister, along the course 
of the sciatic nerve in sciatica are to be interpreted in some such manner. 

Blisters are very frequently used in other regions of the body. Thus, 
used on the knee-joint they are helpful in diminishing suffusion or the col¬ 
lection of water on the knee; at the back of the neck they are often useful 
in relieving chronic headaches; and in chronic joint-diseases in general they 
are often very helpful. In the use of blisters, care should be taken that the 
serum does not become infected. 

The use of blistering agents has diminished considerably within recent 
years, as newer and more effective modes of treatment have come into 
service for such affections in which blisters were formerly used. The argu¬ 
ment is not that blisters are no longer effective—they are as useful as ever 
—but that other methods of treatment are even more serviceable. 

BLOOD. — See Introductory Chapters (pp. 15-17). 

BLOOD-DISEASES. —See Anemia; Blood-Poisoning; Hemophilia; 
Venereal Disease. 

BLOODLETTING (VENESECTION). —A very old remedial and thera¬ 
peutic measure. Certain observers have claimed that animals at times 
deliberately bite into their blood-vessels in order to abstract blood. This 
observation is supposed to have prompted similar experiments in man. 
The old Greek physician Hippocrates, who flourished about 400 B.C., 
recommended the procedure for various ills. Alternately combated, 
praised, used to excess, or almost entirely forgotten, it was-gradually aban¬ 
doned during the latter half of the nineteenth century. More recently, how¬ 
ever, it has again attracted attention. At present venesection is resorted 
to in certain diseases for the purpose of removing the blood from an over¬ 
filled and exhausted heart in order to lighten its work and increase its 
strength. It is employed also to relieve congestion of various organs which 
temporarily contain an excessive amount of blood, and for the purposes of 
removing poisonous materials and stimulating the production of new blood. 
The principal conditions in which bloodletting may be of service are pneu¬ 
monia, pleurisy, heart disease, cerebral hemorrhage (apoplexy), epilepsy, 
and a number of intoxications due to endogenous poisons. 

Venesection is usually done from one of the large veins of the arm; 
sometimes from vessels of the foot. The vein is opened with an ordinary 




183 


THE STANDARD FAMILY PHYSICIAN 


Blood 

Blood-Poisoning 


scalpel, or with a special instrument in which the knife-blade is suddenly 
pushed into the vein by the aid of a spring. The instruments used must 
be aseptic. Before opening the vessel, the limb is constricted with a circu¬ 
lar bandage above the site selected, in order to fill up the veins and make 
them more readily accessible. The resulting small wound heals within a 
few days, during which time the limb must be kept quiet. The patient 
should remain in bed after the operation, in order that the ensuing perspi¬ 
ration may be utilized to its fullest extent. Fainting-spells, or attacks of 
weakness rarely occur during bloodletting; but in order to avoid them the 
procedure had best be conducted in bed. It is not advisable that venesection 
be undertaken by laymen. 

BLOOD-POISONING (SEPTEMIA). —-A general systemic poisoning caused 
by the absorption into the circulation of the poisonous products of certain 
bacteria. It may be complicated by the presence in the blood of the micro¬ 
organisms themselves. The symptoms comprise a high temperature, a 
feeling of weakness and fatigue, a pyemic coma or delirium, and repeated 
chills* Some of these cases are rapidly fatal. There is a popular concep¬ 
tion that many diseases are connected with a previous attack of blood- 
poisoning; and simple inflammation with redness of the surrounding skin 
and swelling of the affected limb is often regarded as a like condition. This 
conception is fallacious, for it is essential that the bacteria or their poisonous 
products gain entrance into the bloodstream before one can properly speak 
of blood-poisoning, or septemia. The first intimation of this is usually a 
severe chill. The only way in which this dangerous condition may be 
avoided is by early and appropriate treatment of every septic inflammation; 
where pus is present it should be removed as soon as possible by proper 
incisions in order to prevent the absorption by the blood of the toxic sub¬ 
stances. 

Some of the worst cases of septemia follow childbirth. In these instances 
lack of cleanliness results in the infection of the wounded surfaces of the 
uterus; and absorption of toxins or bacteria, or of both, bring about puer¬ 
peral fever. The most important septemia-causing micro-organisms are 
the Staphylococcus and Streptococcus pyogenes aureus. Septemia is a factor 
also in many cases of typhoid fever, pneumonia, and syphilis. An entirely 
different type of blood-poisoning is found following the use of certain drugs. 
These remedies are for the most part examples of modern synthetics in 
which the carbolic-acid nucleus forms an integral part. When taken in 
large doses they cause certain changes in the blood whereby its oxidative 
functions are interfered with, either by a fixation of the hemoglobin action 
or by a destruction of the blood-corpuscles themselves. Such diugs as 
acetanilid (an important ingredient in many headache-cure^), antipyrin_ 
sulfonal, etc., may cause poisoning of the blood by rendering its oxidation 
impossible or difficult. As a result of the action of certain olood-poisons, 



Blood-Vessels 

Bone 


THE STANDARD FAMILY PHYSICIAN 


184 


such as rattlesnake venom, the blood-cells are destroyed. See Poisoning. 
It is of interest to note that Oliver Wendell Holmes was the first to teach 
the infectious nature of puerperal septemia. 

BLOOD-VESSELS.— See Introductory Chapters (pp. 62-65). 

BLUES. —See Insanity; Obsessions. 

BODY-LOUSE.— See Lice. 

BOIL. —Term applied to a collection of pus under the skin, which may 
occur during the course of an acute or chronic inflammation of the skin or 



Fig. 93. X-ray picture showing fractures 
of both bones of the forearm (radius and 
ulna). 



Fig. 94. X-ray picture showing fracture of 
ulna (side view). 


other organs. According to whether the pus is the result of an acute or a 
chronic process, so-called hot and cold abscesses are distinguished. The 
former are accompanied by redness of the skin, a feeling of heat in the 
affected part, a severe, pulsating pain, and, usually, fever. A cold abscess 
is free from these symptoms, or they are present only in small degree. The 
superficial forms in the skin are termed boils; the deeper-seated ones, 
carbuncles. 

An abscess results from the effort of the body to combat a bacterial foe. 
If this does not succeed, either because the overlying skin is too thick or 
because some improper mode of treatment, such as massage, has been applied, 
particles of pus are absorbed by the body and distributed to various parts, 
resulting in a general blood-poisoning or pyemia. It is therefore very im- 









185 


THE STANDARD FAMILY PHYSICIAN 


Blood-Vessels 

Bone 


portant to assist in the formation of the abscess by putting the part at rest 
and improving its circulation; and as soon as the pus has gathered, to give 
it free exit by means of an incision into the skin. Rest may be secured by 
putting the limb on a splint.* It should then be kept elevated and furnished 
with a warm, moist dressing. As soon as the abscess is fully developed 
(“ripe”) it should be freely lanced. The most frequent bacterium found 
in boils is the Staphylococcus pyogenes 
aureus. The Bacillus tuberculosis is pri¬ 
marily responsible for many cold ab¬ 
scesses. 

BONE. —For structure, shape, number 
in body, composition, and functions, see 
Introductory Chapters (pp. 28-38). 

BONE, FRACTURES OF.— Complete 
breaking of a bone is designated as frac¬ 
ture. If the break affects only a part of a 
bone section, it is called an infraction; if 
only cracks and clefts are caused, it is 
called a bone fissure, or at times a green 
stick fracture; if only a small part of the 
bone is detached, it is a splinter. In case 
the skin over the point of the fracture is also torn, the fracture is desig¬ 
nated as open , complicated , or compound (see Plate XVI. and Figs. 93, 

94, 95)- 

The surest sign of a fracture is the displacement of the separated parts 
of the bone, which sometimes can be recognized even externally in that one 
or both fragments project distinctly under the skin. Greater certainty is 
afforded by palpation of the skin over the fracture by the physician, so 
long as no material swelling has occurred. Every touch and movement 
which may cause a displacement of the fragments of the bone will give rise 
to great pain. Regularly, owing to simultaneous contusion of the soft 
parts, there is a more or less profuse loss of blood which, with the direct 
injury, causes great swelling. The fractured limb should not be used. 
Healing takes place by the formation of new bone at the fractured ends. 
This bone-mass (callus) is at first soft, but later it becomes very hard and 
firmly unites the fragments of the bone (see Fig. 68). If the fiagments 
remain in the correct position during the time required for the healing, the 
fracture heals straight; otherwise, more or less crooked, as a rule causing a 

shortening of the limb (see Fig. 69). 

If it is not possible in cases of fracture to obtain the aid of a physician 

immediately, emergency splints should be applied; the helper must, how¬ 
ever, make it his only object to allay the pains of the injured, and must 
make no attempt to adjust the displacement of the bones. The bones most 



Fig. 95. X-ray picture showing fracture of 
the thigh-bone, or femur. 







Bone 


THE STANDARD FAMILY PHYSICIAN 


186 


exposed to fracture are the long, tubular ones (upper arm, forearm, thigh, 
and lower leg). After having removed the clothes covering the seat of 
the fracture, which is best done by ripping the seams, the limb should be 
wrapped in wadding or soft cloths; over this should be placed splints made 
irom thin pieces of wood, box-covers, cardboard, tin, bark, or any other 
material that may be at hand (see Figs. 96, 97, 98), and these splints should 



Fig. 96. Emergency splint for fracture of forearm. 


be tied with strips of gauze, linen, rags, shirt strips, suspenders, etc. If 
the fracture is a compound one, great care must be taken to avoid infection. 
An absolutely clean cloth, put in boiling water for ten to fifteen minutes 
and then wrung out, may be applied tightly until the physician arrives. 

Injuries of bones by gunshot wounds and by machinery are shown on 
Plate XVI., Figs. 3, 4, 5. 



Fig. 97. Emergency splint for iracture of the leg. 


BONE, INFLAMMATION OF.—As explained in the Introductory 
Chapters, the bone consists of three parts: the compact bone-mass , the 
periosteum , and the bone-marrow. Inflammation may involve any one of 
these parts, and is then designated accordingly; or, as is usually the case, 
all three parts may be affected by a severe inflammation. 

Acute inflammation of a bone is generally characterized by a sudden 










187 


THE STANDARD FAMILY PHYSICIAN 


Bone 


rise in temperature, with violent pain in the affected bone. A swelling of 
the soft parts covering the bone soon develops, indicating the beginning of 
an accumulation of pus in or about the bone. As the skin, muscles, ten¬ 
dons, and periosteum which bar the pus from reaching the outer parts are 
strong and thick, it gets to the surface very slowly; and on account of the 
great tension under which it is put, it causes severe pain. Absorption also 
takes place, giving rise to the fever. 

The inflammation generally produces a purulent affection of the perios¬ 
teum, varying in extent; and this in turn causes the destruction of a part of 
the compact bone-mass, which is deprived of nutrition coming through the 
blood-vessels of the periosteum. The mortified piece of bone ( sequestrum) 
gradually becomes detached from the unaffected parts, and is cast off. The 



Fig. y8. Emergency splint for a broken bone. 


opening of the abscess and the discharge of the pus do not, as a rule, termi¬ 
nate the morbid process, and the mortified piece of bone may remain behind 
for several months. The discharging pus generally causes a fistula which 
remains open until the sequestrum is fully thrown off. At times, however, 
the dead bone fragment is so large that it can not pass out through the nar¬ 
row opening of the fistula; and as it would require a long time for the 
sequestrum to be disintegrated and discharged, it is better surgery in such 
cases to remove the diseased part of the bone by operation. In this way 
suppuration, which is harmful to the general condition of the patient, is 
arrested as early as possible. Acute inflammation of bone ( osteomyelitis) 
is more common in children than in adults. 

Chronic inflammation in the bone is generally due to tuberculosis; it 
develops much more slowly and insidiously, and accumulations of pus are 
formed mostly without acute pains or high fever. The duration of the 
disease is also much longer; it may extend over years, or it may even be 
altogether incurable. As the destructive process advances step by step, 
continually involving new parts of the bone, the prospects of cure are much 
more unfavorable than in the acute form. Hence, in these cases operation 
should likewise be performed as early as possible, and the diseased portion 









Bone 

Brain 


TIIE STANDARD FAMILY PHYSICIAN 


188 


entirely removed. Chronic hip-joint disease, and chronic humpback are 
diseases of this kind. They are types of localized bone tuberculosis. 

BONE, SOFTENING OF. —A condition which occurs almost only in 
adults, and which is due to a loss of the lime-salts of the bone. The disease, 
which is comparatively rare, affects women principally. It appears that 
it is more frequent in southern Germany and in the Rhine Valley than in 
the northern parts of Germany. It is very common in certain localities in 
Switzerland, northern Italy, and Austria, but comparatively rare in the 
United States. 

The cause and nature of the softening are not thoroughly understood as 
yet. Among the causes which give rise to the appearance of the disease 
are, principally, rapidly succeeding pregnancies, and long-continued nursing 
with insufficient nutrition. It is claimed, further, that damp and dark 
dwellings or bedrooms, improper food (too many potatoes; sour, black rye- 
bread, etc.), and occupations which subject the patient to cold and damp¬ 
ness, play a part in the occurrence of the affection. 

The first symptom of the disease is pain in the bones involved, mostly in 
the pelvis. The pains radiate towards the spinal column and thighs, and 
are at first often taken to be rheumatic. Soon, however, an uncertain, drag¬ 
ging, or peculiarly waddling gait becomes noticeable. Sitting causes pain, 
and the bones bend. The spinal column, no longer able to carry the weight 
of the body, curves backward, and as a result the patients grow shorter. 
When the disease has reached a more advanced stage walking becomes im¬ 
possible, and the patients must remain in bed. 

Although the course of the disease is a slow one, it is not always unfa¬ 
vorable. Cessations and even cures have been observed. It is true, how¬ 
ever, that the danger of a recurrence and progress of the disease is connected 
with every new pregnancy. Treatment is not quite as hopeless as it ap¬ 
pears. If unfavorable conditions of life are present, they should be abol¬ 
ished. Dark and damp dwellings should be exchanged for bright and airy 
ones. The diet should preferably consist of foods which are rich in phos¬ 
phorus and lime; such as eggs, meat, certain vegetables (beans, peas), and 
cheese. Potatoes must be avoided, and food which contains sugar should be 
taken only in moderation, but fruit is admissible. Warm baths in the form 
of sheet packs, with or without additions (salts, brine, herbs), and sun¬ 
baths usually act very beneficially. A comfortable resting-place should be 
provided, with suitable bolsters, water-bags, etc. In addition to cod-liver 
oil, iron and phosphorus are useful medicines in this disease. Recurrence 
of pregnancies should be avoided, if possible. If the disease progresses in 
spite of careful treatment, there remains as a last resort Castration, which 
has given good results. A particular type of bone-softening is seen in chil¬ 
dren who suffer from Rickets. 

BONESET. —See Eupatorium. 




189 


THE STANDARD FAMILY PHYSICIAN 


Bone 

Brain 


BOTULISM. —See Poisoning. 

BOW-LEGS or BANDY LEGS. —Legs which are bent in an outward 
curve (see Fig. 99). They are the result of a curvature of the bones of the 
thighs and lower legs, usually due to rickets. In very small children, bow¬ 
legs may straighten if the cause of the condition, rickets, is treated. In 
older children, one can not with certainty count upon straight growth; and 



Fig 99. Bow-legs or Bandy Legs. 


splints must be used to act upon the deformity. Operation, consisting in 
breaking or chiseling of the curved bones, is necessary only in the most 
severe cases. 

BRAIN. —The chief mass of nervous tissue in the body. In it are con¬ 
nected all of the nervous fibers from the different parts of the body, and it 
serves as the chief organ whereby the different parts of the body are co¬ 
ordinated one with another; more particularly it has the impoitant function 
of fitting man to his environment, through the intellectual piocesscs. The 
brain is an extremely complex organ. It may be likened, very crudely, and 








Brain 


THE STANDARD FAMILY PHYSICIAN 


190 


in a rough mechanical way, to a telephone switchboard. It is the “Central” 
for all forms of activity within the body, as well as those in the outside 
world that may be brought in contact with the body. Through the brain 
all messages from the outside are received, and from it are issued all im¬ 
pulses to perform the different acts that constitute man’s conduct. 

The sense-organs of the body are acted upon by the various stimuli in 
nature; and these, passing through the sensory nerves into the spinal cord, 
are received by the brain, constituting the unanalyzable primary psychic 
atoms, or elements—the sensations. These in turn are perceived, recorded, 
remembered, compared, sorted, etc., and serve to make up thoughts, ideas, 
judgments , etc., varying in complexity, in certainty, and in correctness ac¬ 
cording to the quality of the brain-material (its fiber connections) and the 
richness of its experience. As a resultant of these thoughts, ideas, and 
judgments, acts are performed, constituting a third primary division of the 
functions of the brain. These responses, or acts, may be voluntary , the 
tension of the impulses having passed into the field of consciousness; or 
they may be involuntary, having resulted from reactions between the sense- 
organs, spinal cord, and muscles (spinal reflexes, sympathetic reflexes); or 
the involuntary act may, after having been for years a voluntary act (as in 
walking), by constant repetition cease to be a dominant factor in the field of 
consciousness (so-called sub-conscious acts). 

There is in the brain-substance a certain amount of division of labor, as 
yet only incompletely worked out. A motor area is known; likewise a sen¬ 
sory one. Areas for the understanding of things seen, heard, smelled, or 
touched have been localized. General areas in which complex ideas are 
elaborated are mapped out; but the brain is so infinitely complex that all 
of the fiber-tracts, cell-groups, and connections will be known only after 
many more years of painstaking investigation of the human brain as well as 
of that of lower animals. The mass of known facts, however, fills many 
thousands of volumes. No one human mind knows more than a very 
small fraction of all the facts ascertained concerning the brain. 

BRAIN, APOPLEXY OF. —A suddenly occurring, and usually extensive, 
one-sided paralysis, due to the obstruction or rupture of a blood-vessel of 
the brain. 

Obstruction of a blood-vessel is brought about either by coagulation of 
the blood in an artery of the brain, or by the lodging of blood-clots, formed 
in one of the large arteries of the body, and carried into the blood-vessels of 
the brain by the blood-current. The results are the same in either instance: 
occlusion of the blood-vessel, obstruction to the circulation of the blood, and 
disturbance of nutrition in the form of a softening of the brain-substance. 
It is only occasionally that the occlusion is brought about by the morbidly 
thickened wall of a blood-vessel, which little by little narrows the blood- 
channel and interferes with the circulation; this is the case, for instance, in 





191 


THE STANDARD FAMILY PHYSICIAN 


Brain 


syphilis of the brain. Not infrequently the formation of thrombi is brought 
about by septic infections, such as typhoid fever or pneumonia, and partic¬ 
ularly by acute articular rheumatism. 

The rupture of a blood-vessel, with subsequent flow of blood into the 
brain, is always the result of a vascular affection, which is characterized by 
calcification and brittleness of the wall of the blood-vessel. This calcifica¬ 
tion of veins and arteries occurs especially in an advanced age; it is furthered 
by the abuse of alcohol. The immediate cause of an apoplectic stroke is 
usually a rush of blood to the head, such as occurs after mental emotions, 
or after an abundant meal or a drinking-bout. So-called “apoplectic” indi¬ 
viduals—that is, broad-shouldered, corpulent persons, with short necks and 
flushed faces; who are fond of alcoholic drinks, and who often suffer from 
disturbances of heart and respiration as indicative of an existing disease of 
the blood-vessels—are more prone to hemorrhages of the brain. 

The symptoms of apoplexy due to obstruction of the blood-vessels do 
not differ much from those of apoplexy due to hemorrhage, except in that 
the latter are generally more severe. An attack is frequently preceded for 
days, weeks, and occasionally for months by cautioning “forerunners” in 
the form of headache, dizziness, ringing of the ears, rapidly passing disturb¬ 
ances of speech, and attacks of fainting. The attack proper sets in slowly, 
or rapidly and violently, according to whether the occlusion of the vessel, or 
the hemorrhage, took place gradually or suddenly. In the former case the 
patient becomes mentally uncertain, dull, confused, and staggering; he 
loses the use of his arms and legs, and finally complete loss of consciousness 
takes place, accompanied with usually a one-sided paralysis. In an acute 
attack, such as usually occurs after severe hemorrhages, the patient falls to 
the ground as if struck down,, and loses consciousness at once. His face is 
generally (but not always) flushed, his respiration snoring, and his lips and 
cheeks drawn in and puffed during breathing; his limbs are without mo¬ 
tion, and when raised they fall back, completely relaxed; urine and feces 
are discharged involuntarily. In case the hemorrhage is very profuse and 
affects a vital part of the brain, death occurs; sometimes at once, sometimes 
after a few hours or days, without the patient recovering consciousness. 

More frequently, however, the patients recover from such attacks. The 
blood extravasated into the brain is in part absorbed by the lymph-vessels; 
in part it breaks down or is encapsulated; or it leaves a scar. Conscious¬ 
ness returns gradually, but a one-sided paralysis remains as a result of the 
destruction wrought in the brain. According to the extent of the damage 
to the brain-tissue, these paralyses affect larger or smaller parts of the body. 
They may remain permanently, or they may pass entirely or in part. In 
contrast to paralysis of the spinal cord, brain-paralysis involves only one 
side of the body, and always the side which is opposite to the site of the hem¬ 
orrhage or occlusion; hence a hemorrhage into the right side of the brain 





Brain 


THE STANDARD FAMILY PHYSICIAN 




causes a left-sided paralysis, and vice versa. In severe cases the paralysis 
may extend over an entire side of the body, involving one-half of the 
face, one arm, and one leg. Right-sided paralysis (resulting from left¬ 
sided hemorrhage) is usually associated with a material disturbance of 
speech. 

In case the apoplectic attack runs a favorable course, the patients are 
able after a few weeks again to move their limbs, although only imperfectly 
at first; speech also returns. The degree of improvement which may take 
place in the course of months and years depends entirely upon the severity 
of the lesion, and in part also upon the correct treatment. In very favorable 
cases all symptoms recede, whereas in severer ones some muscles remain 
permanently paralyzed or at least impaired in function. The paralyzed 
limbs, especially the arm and the hand, become affected by contractures, 
as well as by trembling or by movements resembling St. Vitus’s dance. The 
mental capacity of the paralyzed persons is frequently affected as well. 
They may lose their memory, or they may become dull and indifferent; and 
they have no conception of the severity of their malady. It is never possible 
to make a reliable prediction as to the result, the less so as these attacks 
recur frequently. Slight hemorrhages (or occlusions of vessels) cause only 
insignificant disturbances of consciousness, dizziness, ringing of the ears, 
and temporary weakness in arms and legs. 

The best treatment for apoplexy of the brain is the preventive treatment. 
Persons suffering from heart-disease, and old people with changes of the 
blood-vessels and with apoplectic predispositions, should avoid all causes 
which might result in a congestion of blood to the head. They should lead 
temperate lives, abstain entirely from alcoholic drinks, and beware of over¬ 
exertions of any kind. Very little can be done for the treatment of the 
apoplectic stroke itself. The patient should be put in bed, with the upper 
part of the body raised if the face is flushed, and with cold compresses to 
the head. It may be of service also to place the feet in hot water. The 
further treatment, especially that of the consequent conditions, must be 
left to the physician. Alcoholic drinks should be avoided. 

BRAIN, CONCUSSION OF. —A condition brought about by external 
force, by a blow, a knock, or a fall. It results in the loss of consciousness 
and sensation, in vomiting, pallor, retarded pulse, and in superficial respi¬ 
ration. It is often impossible at once to decide whether a fracture of the 
skull is present in addition to concussion of the brain. 

A person who has suffered a concussion of the brain must be moved very 
carefully and cautiously. It is better, therefore, to have him rest provi¬ 
sionally at the place of accident, by using blankets, comforters, bedding, etc., 
until suitable means are at hand to move him to a proper place. In the mean¬ 
time all constricting parts of his dress should be loosened, his head placed 
in a low position, and any bleeding injuries which may be present should be 



193 


THE STANDARD FAMILY PHYSICIAN 


Brain 


attended to. If he is able to swallow, water should be administered. The 
patient should not be transported in a carriage, but on a stretcher; if a 
wagon is used, he should be protected from all shock. Specially con¬ 
structed ambulances are available in large cities. Artificial respiration 
should not be used. A physician must, of course, at once be summoned to 
the place at which the accident occurred. 

BRAIN, DISEASES OF. —In addition to meningitis, cerebral apoplexy, 
dropsy of the brain, and softening of the brain, there are other affections of 
this organ which shall be discussed briefly in this place. 

Disturbances of the circulation of the blood in the brain are among the 
more general causes of disease of that organ. If the blood supply is insuffi¬ 
cient (anemia), the patient becomes pale and dizzy, and subject to fainting 
spells. This condition is brought about by mental emotions, exhaustion, 
loss of blood, weakness of the heart, and by gastric disturbances (long- 
continued fasting). Delicate, weak, chlorotic persons are especially sub¬ 
ject to this disease, and may suffer also in the intervals from headache, 
exhaustion, and ringing of the ears. Regarding the treatment of fainting 
attacks, see the directions under Fainting. To prevent a recurrence of 
the attacks, the best course to pursue is to improve gradually the delicate 
constitution by general hygienic measures. 

Congestion, the opposite of anemia, is the result of abnormal accumula¬ 
tion of blood in the head. The face becomes dark red, the arteries of the 
temple throb, and a sensation of dizziness is felt. The patient becomes 
subject also to attacks of fainting; and even slight, temporary paralytic 
strokes occur (as in cerebral apoplexy). Mental emotions (as anger) are 
the cause also of this condition; but excesses in eating and drinking, great 
heat, and tight clothing are also factors. Patients suffering from congestion 
should be placed in a quiet position, and with the upper part of the body 
raised. A cold-water compress or an ice-bag should be placed on the head; 
a hot foot-bath with simultaneous cooling of the head also diverts the blood 
downward. General treatment to improve the health must be considered. 
This includes the prohibition of alcoholic drinks and of food difficult to 
digest, attention to regular movements of the bowels, avoidance of over¬ 
exertions, etc. 

Tumors of the brain are of considerable importance. They occur not 
infrequently in middle-aged persons, oftener in men than in women, and 
the causes of their origin are but vaguely known. It is often difficult even 
for a physician to diagnose the affection in its early stages. Indistinct, dull 
headache is usually one of the earliest signs; other disturbances appear only 
after weeks and months, and they may vary greatly according to the seat 
and the condition of the tumor. The symptoms include: disturbances of 
vision (very frequent), dizziness, staggering gait, paralysis 01 weakness of 
various limbs, vomiting, a dull stupor, unconsciousness, and loss of memory. 




Brain 

Bread 


194 


THE STANDARD FAMILY PHYSICIAN 


After months, more rarely after years, the disease terminates in death. 
Only such tumors are curable which may be removed by operation, or 

which are due to syphilis (see below). 

Syphilis of the brain does not, as a rule, manifest itself until a long time 
(sometimes years) after the syphilitic infection. The symptoms of this 
disease vary greatly according to whether some syphilitic nodes or a general 
affection of the brain has developed. One form of cerebral syphilis can 
scarcely be distinguished from softening of the brain; another occurs as an 
apoplectic stroke; and a third form presents all the symptoms of syphilis. 
Recovery is possible if the disease is recognized in time. Children with in¬ 
herited syphilis of the brain may remain mentally weak. 

BRAIN, SOFTENING OF. —This designation, as it is used by the laity, 
does not correspond with the scientific name of a distinct affection, tech- 





/Hi CvK^toX, 





Fig. ioo. Handwriting of various paretics. Each specimen contains, besides the name of the patient, 

the words: “ This is a fine day—Manhattan State Hospital.” 


nically known as general paresis or dementia paralytica. It is true, there is 
a genuine softening of the brain-substance (for instance, after a hemorrhage 
of the brain), but this is not identical with the disease to which the laity 
refers. This affection consists in a wasting and destruction of the nerve- 
elements in the cortex of the brain; and it manifests itself, briefly stated, in 
a gradual decay of the mental faculties, combined with a weakness of the 
muscles of the body, which may be increased to loss of their function. 

The disease is of great importance for various reasons; primarily, be¬ 
cause of its frequency. It occurs three to four times as often in men as in 
women; and about ten per cent, of all demented patients admitted into 
asylums are paretics. Further, it is prone to affect patients in the prime of 
life, thirty to fifty years of age. It is almost invariably fatal within a few 
years, although occasionally temporary improvements simulate a cure for 
weeks or months. It is particularly important to recognize this disease in 
its early stages, as the afflicted person often commits foolish or criminal acts. 








195 


THE STANDARD FAMILY PHYSICIAN 


Brain 

Bread 


The following example may serve as an illustration of this: A business man 
who has always been moderate and capable becomes ‘‘nervous”; he does 
not sleep well, grows irritable and restless, neglects his business, drinks, 
associates with women, becomes conspicuous by absence of mind, forget¬ 
fulness, and “inconceivable” social offenses, and he will not listen to well- 
meant counsel. He is looked upon as overworked and neurasthenic, and 
he is made to go into a hydropathic institution. There, however, the true 
nature of his affection soon becomes manifest—his mind deteriorates very 
rapidly, and he may some day frighten the institute by an attack of mania. 

The further course of the disease develops in various manners, but its 
main feature is always a gradual collapse of the mental faculties. The 
memory fails, the capacity of judgment is lost, the mentality is dulled, and 
gradually the patient becomes completely idiotic. It often happens that 
“delirium with exaltation” develops, which may alternate with hypochon¬ 
driacal depression. The deterioration of the mind goes hand in hand with 
that of the body: the faculties of the muscles relax, the gait becomes clumsy, 
the speech stuttering and babbling, and the writing indistinct and trembling 
(see Fig. ioo). Slight paralytic attacks resembling epilepsy occur occa¬ 
sionally, but the patient usually recovers from them; finally, the condition 
is intensified by the supervention of paralysis of the muscles involved in 
swallowing, and failure of the muscles of the rectum and of the bladder. 
The patient, now helpless as an infant, dies with the symptoms of the most 
complete exhaustion, provided pneumonia or another affection has not pre¬ 
viously terminated his unfortunate life. 

The principal cause of paresis is syphilis, which has been either neg¬ 
lected or insufficiently treated. In some cases the paretic condition does 
not appear until ten years or more after the syphilitic infection, and generally 
when other injuries of the nerves (caused, for instance, by the abuse of alco¬ 
hol) are added. There can be no doubt that also non-syphilitic persons are 
affected by the disease, although far more rarely. Heredity also plays a 
part, but less so than in most of the other mental diseases. Paretic patients 
are always best taken care of in an institution, private or public. 

BRAN-BATH. —This is prepared by adding a decoction of 2 to 6 pounds 
of wheat-bran to a full bath of a temperature of 95 0 F. The decoction is 
obtained by boiling the bran in a linen bag, and the extraction as well as 
the boiled bran are thrown into the bath. The bran-bath acts soothingly, 
and is therefore of service in conditions accompanied by itching of the skin. 

BREAD— An article of food which may well be designated as the staff 
of life. The important position accorded to this substance is well merited, 
for it contains the most important elements of nutrition required by the 
body, namely proteids and carbohydrates; it furnishes in abundance the 
salts which are necessary for the building up of the body and for the main¬ 
tenance of good health; and in many instances it serves as a means of ren- 





Bread 

Breast 


THE STANDARD FAMILY PHYSICIAN 


196 


dering other nutrient substances available or palatable. The carbohy¬ 
drates predominate in bread, while meat on the other hand is the type of an 
albuminoid food. The more common varieties of bread are composed of 
the following constituents: 


*- 

Bread made from High-grade 
Flour 

Water 

Per Cent. 

Proteids 
Per Cent. 

Carbo¬ 
hydrates 
Per Cent. 

Fat 

Per Cent. 

Ash (Salts) 
Per Cent. 

Low proteid bread. 

30.0-33.0 

7 -o- 7-5 

55.0-60.0 

O 

bo 

1 

H 

b 

00 

6 

1 

6 

Medium proteid bread. . . 

32.0-34.0 

9.0-10.0 

55.0-60.0 

1.0-1.5 

0.8-1.0 

High proteid bread. 

34.0-36.0 

10.0-12.0 

50.0-53.0 

0 

M 

1 

O 

0.4-0.6 


The amount of fat in bread varies widely according to the richness in 
cream of the milk used, or the amount of lard or butter incorporated. 
Breads made from bolted wheat .(white flour), from entire wheat, or from 
whole kernel (Graham flour) will also vary in their percentage of proteids 
and other ingredients. Thus, chemical analyses show the general differ¬ 
ences in these flours as follows: 



Proteids 

Per Cent. 

Carbo¬ 
hydrates 
Per Cent. 

Fat 

Per Cent. 

Ash (Salts) 
Per Cent. 

Graham flour..... 

Entire wheat.. 

12.0-13.0 
12.0-12.5 

IO.O-I 2.0 

74 . 0 - 75.0 

73.O-74.O 

75.O-76.O 

2 . 0 - 3.0 

2.0-2.5 

I. 5 - 2 .Q 

1.0-2.0 

1.0-1.5 

0.5-1.0 

White flour..... . 



Bread which has been prepared with milk contains a much larger pro¬ 
portion of proteid materials. This is true not only on account of the flour, 
but also because the milk employed constitutes an important factor in supply¬ 
ing food-elements. Among the breads prepared with flour and water only, 
the variety known as Graham bread contains the largest quantity of proteids, 
because in addition to the flour there is a considerable amount of gluten 
present, which contains the greater part of the proteids of the grain. These 
are more or less concentrated in the outer coverings, which are discarded in 
the ordinary processes of milling white flour; and the more starchy elements 
situated in the center of the grain predominate in the flour. A comparison 
made between the chemical composition of the different varieties of bread 
and the various kinds of flour shows how great the loss of proteids may be 
when the gluten is not employed. 



Wheat 

Rye 

Barley 

Oats 

Corn 

Rice 

Proteids (per cent.). 

Carbohydrates (per cent.). ...... 

12.35 
67.9 1 

II.52 

67.81 

11 . 14 
64 83 

10.41 

57-78 

9-25 
68.41 

7-85 

76.52 


Bearing in mind the great nutritive value of the proteids, it would seem 
a very wasteful procedure to discard the gluten in baking; the digestive 
processes, however, not only excuse this waste, but as a matter of fact 






















































197 


THE STANDARD FAMILY PHYSICIAN 


Bread 

Breast 


demand it. For to many people the outer coverings of the grain act as an 
irritant to the intestines; and although these special breads may serve as 
dietetic agents and gentle laxatives, they do not necessarily aid the digestion, 
but may produce disturbances of this function, particularly in susceptible 
individuals. The irritation set up in the intestines does not permit the in¬ 
gested food-material to remain in the gut sufficiently long to become fully 
absorbed, so that it may be quite fairly stated that gluten-bread represents 
a very wasteful article of food, and that the finer varieties of bread must be 
looked upon as more suitable nutriment. So long as no process has been 
discovered by which the gluten may be separated from the outer shell of 
the grain in making flour, it is considered wiser by some to employ it as 
fodder for animals, where a suitable mode of digestion is provided for this 
purpose, rather than to incorporate it into bread in the belief that it increases 
its nutrient value. 

The great difference in the percentages of nutrient substances in the 
various grains and their products when made into bread, is due not only to 
the loss of proteids in the gluten, but is largely brought about by falsely 
conceived methods of baking. Bread must be light in order that it may be 
properly attacked by the digestive juices. By the aid of fermentation the 
starch-cells are ruptured, and may thus be more readily acted upon. When 
this is accomplished by the addition of leaven, the process consumes about 
20 per cent, of the nutritive value of the bread—a very considerable loss. 
It is essential, therefore, that the ordinary methods of baking be abandoned 
and that Liebig’s principle be more fully recognized, which prescribes, 
instead of leaven, a baking-powder mixture of an alkaline carbonate and 
an acid. In the baking of cake and pastry this recommendation has long 
been followed, and in addition to the use of yeast for this purpose there are 
now a number of very efficient baking-powders on the market. As the 
dough rises, it may result in the formation of scattered areas in which no fer¬ 
mentation has taken place, and which prove an obstacle to digestion. These 
should not be eaten; nor is it advisable to eat much hot bread, for the latter 
undergoes further fermentation in the stomach, and may cause a great deal 
of distress. Persistent eating of hot bread and biscuits may even lead to 
gastric catarrh. 

BREAST, CANCER OF.— An affection which occurs, not only in older 
women, but also in those who have not yet reached middle life. Usually 
the patient’s attention is directed to the condition by finding a hard nodule 
in the breast which may or may not be painful. The discoveiy is \ci\ often 
accidental. A cancer of the breast rapidly invades the axillary glands and 
may lead to secondary deposits also in other parts of the body, such as the 
lungs or the bones. Every hard nodule in the breast should at once be sub¬ 
mitted to the inspection of the physician, and if opeiation is recommended 
his advice should be followed, for cancer of the bieast may be cured by a 



Breast 


THE STANDARD FAMILY PHYSICIAN 


198 


surgical operation. The earlier this is done, the more favorable are the 
prospects for a permanent cure. But even in those cases where the growth 
has already involved the axillary glands, a cure may yet be possible. It is 
necessary in such cases, not only to remove the affected breast but also the 
axillary glands of the affected side. After operation it is desirable that the 
patient submit to regular subsequent examination by a physician, so that 
any recurrence may be detected and removed as soon as possible. This 
greatly enhances the chances for permanent relief. 

For the reasons just stated it can not be too firmly impressed upon the 
lay mind, that the employment of any of the numerous popular or secret 
nostrums is waste of very valuable time, the remedies themselves being ab¬ 
solutely ineffective. The so-called natural methods (air, light, water, etc.) 
are likewise worthless, and have never yet succeeded in curing the disease.* 
A person should never be misled by the claims made for these methods, nor 
by the publication of pretended cures. In the presence of true cancer, the 
only way to eliminate the growth is by early and thorough operation. Too 
much faith must not be placed in the X-ray treatment. Although useful in 
some cases of flat cancer, the X-ray treatment is generally useless in deep- 
seated carcinoma of the breast. 

BREAST, INFLAMMATION OF. —A condition which is essentially the 
result of the resistance offered by the body against bacteria which have 
invaded the glandular tissue of the breast. In order to combat this invasion, 
the organism sends an increased amount of blood to the part, causing as a 
result pain, swelling, local heat, and redness. This reparative effort may be 
sufficient to overcome the bacteria and render them harmless. If in any 
given locality the bacteria gather in preponderating numbers, the leuco¬ 
cytes, or white blood-cells, leave the blood-channels in hordes and literally 
devour the offending invaders. This process results in suppuration and 
abscess formation, and the further advance of the bacteria is halted by a 
surrounding wall of inflammatory tissues. Minute collections of pus scat¬ 
tered among the tissue-spaces may be entirely absorbed by the lymphatics. 
As the bacteria, in addition to their local destructive action, also produce 
toxic substances which are taken up by the system, severe general disturb¬ 
ances may be observed from the very first. These consist in increase of 
temperature and pulse-rate, and in more or less marked prostration. These 
symptoms are especially severe, because the blood- and lymph-vessels, par¬ 
ticularly in the breasts of nursing mothers, are well developed and consid¬ 
erably dilated, wherefore the toxic materials are taken up by the system in 
large amounts. When there is a constantly increasing collection of pus in 
any one locality, the surrounding tissues become separated, or may even be 
destroyed. In this manner the abscess gradually works its way to the skin, 
and finally breaks through the latter. This process may be hastened by the 
application of hot poultices, mustard-plasters, etc. 




199 


THE STANDARD FAMILY PHYSICIAN 


Breast 


In addition to the general symptoms already noted, there are those due 
to the local process, similar to those from any other inflammation: local 
redness and heat, and a gradual loss of function, the milk giving out although 
the breasts are tense and apparently distended. The temperature may rise 
to 104° F. (40° C.) or more, but this does not seem to be of any great moment. 
Life is endangered only in exceptional instances, where there is a very 
virulent infection in the presence of lowered vitality and consequent dimin¬ 
ished resistance in the patient; or where some method of treatment has 
been employed which retards rather than aids the natural process of 
resolution. 

Unfavorable conditions, and neglect in giving the trouble proper atten¬ 
tion may lead to very extensive suppuration of one gland, with involvement 
of the second, so that nursing is not only entirely interrupted, but the moth¬ 
er’s recovery may be protracted for weeks and months. When suppuration 
has once begun, it can with difficulty be retarded; but it is possible to re¬ 
strict the inflammation in the early stages by the continued application of 
cold, which must be done under the direction of the physician. As soon 
as pain and discomfort is observed during the period of nursing, medical 
advice should be sought at once. 

It is, however, even more important to avoid the possibility of this 
trouble. The points of entrance for the infectious organisms are usually 
small cuts and tears on the tender skin of the nipples, which give rise to a 
burning pain when the child is given the breast. Under these conditions 
the child should be nursed only with the aid of a nipple-shield. If the sen¬ 
sitiveness continues, even after the application of alcohol, antiseptic solutions 
(boric acid), or other cooling lotions, nursing from the affected breast 
should be stopped at once. The physician had better be called in consul¬ 
tation, especially if portions of the breast have become red and tender. The 
abrasions are often hard to find; nevertheless bacterial contamination may 
readily take place from contact of the wounded nipple with the under¬ 
clothes, from the mouth of the infant while nursing, or from being touched 
with dirty fingers. The cloths used for the antiseptic applications should 
be changed every half hour; if adherent they should not be pulled off 
roughly, but only after being thoroughly wet. The manner of avoiding 
the production of these abrasions and subsequent infection will be found 
fully described in the article on Nursing. 

Inflammations of the breasts also occur in infants. The glands may 
swell to the size of a walnut, and become red and tender. Suppuration 
rarely follows, such as that which in adults leads to deformity of the nipple 
and inability to nurse properly. In these cases the inflammation should 
also be treated from the very beginning with antiseptic applications. In no 
case should the inflamed gland be subjected to pressure. The infectious 
organisms usually reach the interior of the little ducts in the nipples either 





Breast 

Bronchitis 


THE STANDARD FAMILY PHYSICIAN 


200 


during delivery, when there is a contagious vaginal secretion present, or 
later on from uncleanliness. 

BREAST, PAINFUL AFFECTIONS OF.— Severe cutting and pricking 

pains sometimes noted in the breasts of nervous women. The mammary 
glands of these patients are not apparently affected by any organic disease. 
The pain may become almost unbearable and cause considerable mental 
anguish, the patients being falsely led to believe that they are afflicted with 
cancer. In many instances the pains may be made to disappear quite 
rapidly by a simple mechanical procedure: The patient takes the breast, 
which is usually very much relaxed, with both hands and stretches it like a 
rubber ball in both directions, particular attention being given to the tender 
areas. This is continued until the entire gland has been manipulated, and 
may be repeated as often as necessary. The procedure is not very agreeable, 
but the results are gratifying. Later on the breast may be covered with hot 
applications or wrapped up in cotton. 

BREAST, TUMORS OF. —Tumors, both benign and malignant in char¬ 
acter, may be found in the female breasts. Inflammatory processes, like 
tuberculosis,- also give rise to tumefaction. Benign tumors are removed 
readily and without danger by a simple operation. It is imperative to 
consult a physician at once on the appearance of the first evidences of a 
tumor in the breast, and let him decide whether it is benign or malignant. 
See also Breast, Cancer of. 

BREATH, FOUL. — A condition which generally results from disease of 
the mouth, especially of the teeth. Some of the causes are decayed teeth, 
inflammation of the gums, and artificial plates which are not kept clean. 
Regarding treatment see Teeth, Care of. When the mouth of a very 
sick person smells, thus affecting his appetite, it is very important to cleanse 
it thoroughly by brushing teeth, gums, and tongue. Foul breath may be 
caused also by abnormal conditions of the cavities of the nose and upper 
jaw, by diseases of the windpipe with malodorous discharges, by diseases 
of the throat, stomach, intestine, and urinary organs, and also by anemia 
and diabetes. Disease of the mouth, however, is most frequently respon¬ 
sible for the condition. In addition to treatment of the fundamental trouble, 
a refreshing mouth-wash will prove beneficial. 

BREATH, SHORTNESS OF. —Under normal conditions the adult male 
draws 16 to 18 breaths per minute; the adult woman, 18 to 20. New-born chil¬ 
dren breathe 40 times and more per minute; young children, 25 times per 
minute. Disturbances of the frequency of breathing and of the depth of 
the individual respirations occur in so many morbid conditions of the air- 
passages, and also of other organs, that it is only exceptionally that they may 
serve to indicate the nature of the existing disease. 

The respirations increase in number after every mental, and especially 
after every bodily, exertion; in short, after conditions which increase the 




201 


THE STANDARD FAMILY PHYSICIAN 


Breast 

Bronchitis 


activity of the heart. The increase may be said to be morbid if painfulness 
exists in any part of the body which is put in motion by respiration (as in 
pleurisy, fracture of a rib, rheumatism of the muscles of the chest, inflam¬ 
mation of the abdomen, etc.). Increased respiration is brought about by 
any febrile condition, and most particularly by affections which interfere 
with the exchange of gases in the lungs. This is true whether the passages 
through which the air enters the lungs are narrowed (as in bronchitis, or 
asthma) or whether the pulmonary vesicles in which the exchange of gases 
takes place are impervious (as in pneumonia). Narrowing of the air- 
passages may occur in any individual part of the respiratory canal, from the 
nose to the finest branches of the bronchi, being caused by such diseases as 
tumor of the nose, swelling of the tonsils, goiter, croup, diphtheria, severe 
affections of the larynx, and swelling of the mucous membrane of the bron¬ 
chi. Impervious conditions of the pulmonary vesicles are brought about 
by pressure upon the lungs (in consequence of fluid, air, or tumors in the 
pleural cavity), by filling of the pulmonary vesicles with fluid or semi-solid 
masses (in inflammation and dropsy of the lungs; and in cheesy disintegra¬ 
tion of the pulmonary tissue), or by loss of the elasticity of the pulmonary 
tissue, which causes it to be less expansible as well as less contractile (as in 
emphysema of the lungs). 

The greater the diminution of the respiratory surface, and the more rap¬ 
idly this diminution occurs, the more marked becomes generally the short¬ 
ness of breath. The increase of the obstacle to respiration causes the blood 
to become poorer in oxygen and richer in carbon dioxid gas; and the 
overcharging of the blood with the latter poisonous element irritates the 
respiratory center in the medulla oblongata (that is, the collection of nerve- 
cells governing the function of respiration). 

Shortness of breath may result from certain affections of the heart, 
which cause an overabundance of blood to be conveyed to the lungs. It 
may be present also in diseases of the abdominal organs if such organs 
become enlarged sufficiently to force the diaphragm upward, or to impair 
its ability to contract. Obstructions to respiration usually cause an increase, 
rather than' a decrease, in the frequency of breathing. A decrease occurs 
when the larynx and the windpipe are narrowed (as in croup or diphtheria), 
or when an affection of the brain develops in the course of diseases of the 
lungs. Shortness of breath shows a peculiar character in Asthma and in 
spasm of the Glottis. 

BRIGHT’S DISEASE. —See Kidneys, Diseases of. 

BRONCHITIS (BRONCHIAL CATARRH) .—Inflammation of the mu¬ 
cous membrane of the bronchi and their branches. The disease may occui 
as an acute or as a chronic affection; it may implicate one side 01 both, it 
mav affect either only the larger, or only the finci ramifications of the 
trachea; or it may involve the entire “bronchial tree” (see Fig. 52). 





Bronchitis 


THE STANDARD FAMILY PHYSICIAN 


202 


The most frequent causes of bronchial catarrh are colds (caused by sud¬ 
den cooling of the heated body, by drenching, or by the breathing of cold, 
damp air), and the inhalation of dust, smoke, or gas. Noxious gases are 
especially dangerous. The fumes of nitric and sulfuric acids, the vapors of 
bromin and chlorin, and the dust of vegetable detritus are all injurious. 
Mineral and metallic dusts, including those which owing to their sharp 
points and rough surfaces greatly irritate the mucous membrane, and in 
part even directly injure it, are even more to be avoided. Certain trades, 
such as the stone-cutter’s, carpenter’s, miller’s, baker’s, paperhanger’s, 
turner’s, and file-cutter’s, are dangerous because of the contact with dust. 
Experience also shows that children, the aged, and persons affected with 
scrofula or with diseases of the heart or lungs, are much more liable to be 
attacked than thoroughly healthy persons in the prime of life. 

Acute bronchitis occasionally sets in with a sudden rise of the tempera¬ 
ture of the body, even with a violent chill. In many cases, however, it is 
entirely free from fever. If the affection is very severe, the general condi¬ 
tion is also impaired. The most essential symptoms are cough and expec¬ 
toration. The patients continually have the sensation of tickling in the 
throat and of soreness behind the upper part of the breast-bone, sometimes 
along the entire breast-bone; they are tormented by an annoying irritation 
to cough, without, however, being able to expectorate much, at least not in 
the beginning. A so-called dry cough is present. The accumulation of 
viscid mucus in the bronchi causes, upon the passage of the respired air, the 
occurrence of humming sounds in the chest, which are often noted by the 
patient, and even some distance from him. So long as the cough is painful, 
and the sputum can be expectorated only with difficulty, the sleep of the 
patient is impaired. Solely as a result of the exertions to cough, and the 
consequent rush of blood to the head, there arise headache, a sensation of 
vertigo, nausea, and even vomiting. After a few days the sputum, which at 
the onset was viscid, mucous, and thread-like, usually becomes more fluid, 
mucopurulent, and sometimes altogether purulent. This causes the cough 
to become easier—more moist; the catarrh is looser. Pains in the chest, 
which generally are present only in the more severe cases of bronchial 
catarrh, are not caused by the affected mucous membrane of the 
bronchi; they are due to overexertion of the diaphragm and of the muscles 
situated between the ribs, in consequence of violent paroxysms of 
cough. 

If the catarrh becomes localized in the finer branches of the bronchi, it 
is followed almost regularly by fever, and the respiratory disturbances may 
be marked. In children and old persons the affection may implicate the 
lungs ( bronchopneumonia ), where it will form scattered areas of inflamma¬ 
tion, thereby endangering life, especially in small children. The milder 
forms of an acute bronchial catarrh generally take a favorable course, and 





203 


THE STANDARD FAMILY PHYSICIAN 


Bronchitis 


disappear in a week or two; even the most severe cases usually terminate in 
cure if carefully treated. 

Chronic bronchitis either develops as a chronic condition from the be¬ 
ginning, or it results from recurring, especially neglected, acute attacks. 
Its most frequent cause is the continued inhalation of dust, particularly in 
industrial concerns where much dust is present. Affections of the heart, 
of the blood-vessels, and of the lungs, may lead to congestions in the blood¬ 
vessels of the lungs, and thereby to chronic catarrh of the bronchi. The 
most essential symptoms are also in this case cough and expectoration. 
The cough is obstinate, particularly in the morning, evening, and night, and 
may cause nausea and even vomiting. Some patients have little or no 
sputum; in others there are expectorated small quantities of viscid, mucous 
sputum. Many patients bring up profuse masses of a thin, watery, mucous 
or mucopurulent matter. Slight traces of blood may be found in the ex¬ 
pectorated matter, without pulmonary tuberculosis being present. If the 
chronic catarrh spreads to the finer ramifications of the bronchi, respiration 
will become impaired. 

The course of the affection varies. The condition greatly improves 
during the warm season, and becomes aggravated during autumn and winter 
when new harmful influences are active. If the disease persists for many 
years, there is danger that a dilatation of the lung-vesicles may occur, and 
that enlargement of the heart may develop. 

The best preventive against bronchial catarrh is to avoid carefully all 
harmful influences which are known to produce the condition, or which 
favor its occurrence. Rooms which are filled with dust, smoke, or irri¬ 
tating gases should be avoided, and a healthy, dry place of residence 
selected. The hardening of the skin to the influences of variations of tem¬ 
perature is of inestimable value. See Hardening. 

Although experience teaches that acute bronchial catarrh usually runs 
a favorable course, it should be borne in mind that this is still more the case 
if the affection is carefully treated. If fever develops, much time may be 
saved, and much suffering avoided, by remaining at home, preferably in bed, 
and securing the advice of a medical practitioner. The majority of people 
live in hopes that nature will cure “such little colds,” and sometimes they 
believe they overdo matters by taking hot drinks and getting into a perspi¬ 
ration. Such domestic remedies are often sufficient to check a mild, begin¬ 
ning bronchitis, but in many cases they fail; and it is rarely wise to assume 
the responsibility, especially when children or elderly people show the man¬ 
ifestations of bronchial irritations. 

The treatment of chronic bronchitis often presents many difficulties, 
particularly when the patient is unwilling or unable to withdraw from the 
harmful influences which caused the affection, or which are aggravating it. 
The prospect of ultimate recovery is present only if the patient leads a fit- 




Bryonia 

Burns 


THE STANDARD FAMILY PHYSICIAN 


204 


ting, rational life. The irritants to be feared and to be avoided are smoke 
and dust, alcohol and tobacco. A change of residence is often advisable. 
A sojourn in health-resorts (as Bermuda, Florida, or the pine-woods of New 
Jersey) is often helpful; not because remedies are to be obtained in these 
places which are not available elsewhere, but because many patients only 
in this manner will be able to enjoy a perfect bodily rest, away from the 
harmful influences that prevail at their homes. The actual treatment 
should be left to the physician, since it is not always merely a question 
of combating cough and expectoration; the main thing is often to cure,, 
or alleviate, the original disease which causes the cough (such as heart 
defects, kidney diseases, gout, and alcoholism). If these causative affec¬ 
tions can be improved, the result is usually an essential recovery from the 
bronchitis. 

BRYONIA. —The dried root of Bryonia alba , a cucumber-like plant 
growing in Europe. The root contains one or more active glycosides which 
are extremely bitter, and which have a very active cathartic action. Bry¬ 
onia has been used as a cathartic from time immemorial. As it is very 
violent it has often been used as an abortifacient. It causes copious, watery 
stools; and in large doses poisoning with violent abdominal pains, sweating, 
reduction of temperature, and death from collapse. 

BUBO. —An inflammation and enlargement of the inguinal glands, 
brought about by the entrance of infectious substances into the lymph- 
channels. They manifest themselves as painful tumor formations in the 
groin, and follow contaminated wounds and injuries of the lower limbs, or 
more especially certain sexual diseases, primarily soft chancre, gonorrhea, 
and simple inflammation of the prepuce. Non-painful swellings in the 
region of the groin occur in cases of hard chancre (see Venereal Disease). 
The swellings of the glands of the groin in soft chancre show a decided tend¬ 
ency to suppuration. It is possible that these may recede, if the patient 
remains quiet and applies cooling poultices; but if suppuration and soften¬ 
ing have occurred, perforation takes place at one or several points in the 
external skin (formation of fistula), unless an operation be previously per¬ 
formed. If the condition is still further neglected, especially in weakly and 
scrofulous persons, numerous fistulous ulcers form which undermine the 
skin and are difficult to heal. The fistulous canals which penetrate the skin 
in several places discharge a thin, putrid pus. If surgical aid is not rendered, 
the continued suppuration and the loss of substance connected with it lead 
to a long-lasting sickness which, in the course of time, will exhaust the 
strength of the patient. 

Prevention of swelling of the glands of the groin is best accomplished by 
a corresponding hygienic conduct in the existing inflammatory affection 
responsible for the condition; above all, by rest and scrupulous cleanliness, 
and by the earliest possible diminution of the infectious character of a 






205 


THE STANDARD FAMILY PHYSICIAN 


Bryonia 

Burns 


venereal ulcer by medical treatment. A painful inflammation of the in¬ 
guinal glands once being present, the patient should keep quietly in bed, 
and apply cooling poultices until the physician arrives. After softening has 
set in, it is advisable to lance the swelling as early as possible. If necessary, 
this should be followed by extirpation of the affected glands, as this will 
essentially shorten the course of the disease and prevent further complica¬ 
tions. The application of pap-poultices, ointment-bandages, etc., often 
practised after the ulcers are opened, is very inadvisable. 

Attention may finally be called to the fact that, in soft chancre, it 
often occurs that there arises at the site of the opened bubo a new, large, 
chancrous growth (chancrous bubo), which sometimes destroys extensive 
portions of the skin. The surest preventive against this disagreeable con¬ 
sequence is energetic, operative treatment, consisting in extirpation of the 
affected lymph-glands. 

BUBONIC PLAGUE.— See Plague. 

BUCHU. —The leaves of a species of Barosma , derived from South- 
African shrubs. The active principles are volatile oils and resins with an 
active glycosid, barosmin . Buchu is widely used as a stimulant for the 
mucous membrane of the genito-urinary tract, and has been employed for 
many years in the treatment of subacute cystitis, prostatitis, and chronic spe¬ 
cific urethritis. It is a very disagreeable drug to take, and can not be 
recommended on the ground of its palatability. 

BURNS. —Injuries caused by contact with fire, hot objects, molten 
metals, hot water or steam ( scalding ), or acids or alkalies ( cauterization ). 
Distinction is made between slight, medium, and severe burns; or burns of 
the first, second, and third degree. Burning appears either as reddening 
of the skin (first degree), blister formation (second degree), or as charring of 
the skin (third degree). 

The treatment of injuries sustained by burning varies according to the 
degree of severity. For reddening of the skin, it is sufficient to powder the 
affected parts with flour, talcum, zinc oxid, or starch; or to apply olive-oil, 
fat, white of egg, vaselin, or lanolin. If blisters are present they should be 
left unopened, and ointment of boric acid or of zinc oxid applied in order 
to alleviate the pain by excluding the air. The injured parts should be 
covered with a quantity of cotton, secured with a bandage. Applications of 
cold water should be avoided, as they tend to increase the pain. In every 
case of burning, and especially in the medium and severe forms, it is neces¬ 
sary to consult a physician, inasmuch as severe inflammations and lasting 
suppurations may arise from continued unskilled home-treatment. Severely 
burned persons must be put in charge of a physician or a hospital without 
delay. In case of cauterization of the skin by acids (nitric, sulfuric, 
carbolic, etc.) the injured parts should first be washed with water, where¬ 
upon soda, green soap, chalk, or lime-water should be applied; for burns 




Butter 

Caffein 


THE STANDARD FAMILY PHYSICIAN 


206 


from lime or alkalies (soap-lyes) copious quantities of vinegar and water 
should be used as a wash. 

If a person’s clothing catches fire, throw a blanket, a rug, or any article 
of clothing over him, and roll him in this covering on the floor in order to 
extinguish the flames. Then pour water over him, and cut his clothes from 
him with a sharp knife or a good pair of scissors. If the burned person is 
thirsty he should be given warm water to drink. 

BUTTER. —An article of food usually prepared from cream derived from 
milk which has been allowed to stand for some time. Such cream contains 
about 25 per cent, of fat, while that obtained from freshly drawn milk con¬ 
tains only 3 to 3 J per cent. The best butter is made from cream obtained 
by centrifuging, a method much in vogue at the present day. In order to 
preserve the butter, salt is added, but in this way the delicate taste of sweet 
butter is entirely lost. The composition of good butter is as follows: water, 
6 to 18 per cent.; casein, \ to 3J per cent.; fat, 80 to 95 per cent.; and salt 
up to 6 per cent. 

Substances productive of harm, which are found in milk, are present also 
in butter; and a large number of bacteria, including those of tuberculosis 
and typhoid, have been found in that product. It would, however, be 
ridiculous not to eat butter for this reason, since these germs of themselves 
do not necessarily cause disease; the body must be in a condition favorable 
to permit them to multiply. It is important to avoid the possible harm 
resulting from the ingestion of rancid butter; this condition can readily be 
detected by the sense of smell because of the evolution of free butyric acid. 
Light and air both hasten the process of decomposition, for which reason a 
dark and cool place should be provided for storing the supply of butter. If it 
is desired to store butter for a prolonged period, it is necessary to free it from 
all water and casein by melting, and then to add from 1 to 3 per cent, of 
salt. The latter product melts at 58° F.; pure butter anywhere from 55 0 
to 66° F.; and artificial butter at between 40° and 55 0 F. The manner of 
distinguishing artificial butter, or oleomargarin, from natural butter is other¬ 
wise very difficult; for in the highly developed processes of manufacture, 
even the taste of the pure butter is cleverly imitated. Some information 
may be gained by melting the butter and noting the character of the foam 
and the sediment. In rubbing good butter between the fingers there 
should be an absence of all grittiness, and it should not afford the sensation 
of being greasy or mushy. Rancid butter may be improved by kneading it 
with milk or buttermilk. 

In addition to the adulteration of butter by the incorporation of other 
fats or of too much water, mention may be made of the otherwise harmless 
methods of coloring this product with certain preparations. This would 
undoubtedly be stopped at once if the public would accustom itself to look 
for dark butter only during the grazing season, and not at other times of 





207 


THE STANDARD FAMILY PHYSICIAN 


Butter 

Caffein 


the year to see any disadvantage in buying butter which is light in color on 
account of the dry fodder given to the cattle. 


c 

CACAO (COCOA). —A brown powder which is obtained by roasting and 
grinding the oval beans of the cacao-tree (Theobroma cacao), a native of the 
tropics, especially of tropical America. The beans are embedded in the 
cucumber-like fruits of the tree. The cacao-mass contains the following 
constituents, the quantities varying according to its origin: Fat (cacao- 
butter), 45 to 49 per cent.; starch (carbohydrates), 14 to 18 per cent.; proteids, 
13 to 18 percent.; theobromin and caffein, 1.2 to 1.5 per cent. Hence cacao 
is a food as well as a cerebral stimulant. It is a food because of its con¬ 
tents of fat, starch, and proteids, and a cerebral stimulant by virtue of the 
alkaloids (theobromin and caffein) which it contains. The percentage of 
cerebral stimulants in cacao is less than in tea or coffee; and from this 
standpoint cacao is therefore less injurious than these. 

Divested of its fat cacao becomes less nutritious but more readily digest¬ 
ible, the cacao-butter being digested with considerable difficulty. Most of 
the cacaos on the market have had a certain percentage of their fat removed, 
and it is therefore necessary, when they are prepared for drinking purposes, 
to add milk or cream in order to impart a sense of richness to the beverage. 
Cacao with the addition of sugar and a flavor, usually vanilla, constitutes 
chocolate. The cacao-butter is widely used as a basis for suppositories 
and pomades. 

CADAVER POISONS. —The activity of putrefactive bacteria causes in 
the dead body a process of decomposition which ultimately breaks down 
the body-tissues. This process develops chemical substances which are 
very poisonous ( i.e ., causing inflammation) to the tissues of the living body, 
if brought into too close contact. The uninjured skin protects against these 
substances, but persons who handle dead bodies (undertakers, medical stu¬ 
dents, taxidermists, etc.) should exercise great care that they do not get 
infected through scratches, abrasions, or small wounds which had remained 
unnoticed. 

CADE, OIL OF. —A thick, ill-smelling oil distilled from Juniperus oxy* 
cedrus and widely used as a stimulant application to chronic affections of 
the skin, particularly in chronic, dry, scaly diseases, as eczema and psoriasis. 

CAFFEIN.— An alkaloid characteristic of coffee, and also found as 
caffein, or a slight modification, in a number of substances used as bever¬ 
ages, notably tea, cacao, guarana, Paraguay tea, etc. It is particularly 
noteworthy in that it is chemically a xanthin, an ammonia alkaloid, and it 
is related to a number of similar products found in meat. Physiologically 
it is interesting because of its action on the nervous system. It stimulates 





Calcium 

Cannabis Indica 


THE STANDARD FAMILY PHYSICIAN 


208 


the cerebrum, causing wakefulness and an increased facility for work. It 
also has a stimulating action on the heart and blood-vessels, and causes an 
increased flow of urine. 

CALCIUM. —A widely distributed element occurring most commonly 
in limestone as calcium carbonate. It is an important constituent of the 
bones and teeth, forming the inorganic basis of these structures. The effect 
of an insufficiency of lime-salts in the bones is shown in the bony deform¬ 
ities which occur in Rickets. Probably the most common form of calcium 
employed in medicine is chalk, used in chalk mixture for diarrhea. Chalk 
is a calcium carbonate made by chemical action on the shells of various 
mollusks. It is a soft, white substance, insoluble in water, and having an 
earthy taste. Chalk is one of the remedies often given for watery diarrhea, 
because it has a slight astringent action and tends to overcome intestinal 
acidity. The dose of the compound chalk mixture is about a teaspoonful. 
Lime-water, a very weak solution of calcium hydrate, is also frequently used 
as an antacid. 

CALOMEL. —Mild mercurous chlorid (Hg 2 Cl a ), one of the most im¬ 
portant of the mercury compounds used in medicine. It is used in a vast 
variety of ways, but chiefly in vapor form, by sublimation, for the treatment 
of syphilis; and in its powdered form, usually triturated with sugar of 
milk, for internal use. Calomel, like all of the mercury salts, is an irritant, 
but being almost insoluble its irritating action is slight, or long delayed. 
It is used as a stimulating dusting-powder in many chronic skin-affections, 
and also in many chronic forms of keratitis. Internally it is used in the 
treatment of syphilis, but more often as a cathartic. Being irritating it 
stimulates the muscular movements of the alimentary canal, and thus 
empties the intestine, usually in from 6 to 8 hours after taking. It stimu¬ 
lates the gall-bladder also, and thus aids in emptying this viscus; but it has 
not been proved that it has any specific action on the secreting power of 
the liver-cells, notwithstanding the wide belief in the power of calomel to 
“stir the liver.” 

Calomel is particularly valuable as a cathartic, as it clears the intestine 
of its contents; and by causing an increased discharge of bile from the gall¬ 
bladder it adds an additional amount of that important secretion to the in¬ 
testinal contents. This is particularly valuable in that condition known as 
“biliousness,” in which the mild catarrhal inflammation of the duodenum, 
spreading to the biliary passages, tends to limit somewhat the discharge of 
bile into the intestines. 

CALUMBA. —The root of an African vine, Jateorhiza palmata. It con¬ 
tains a neutral body, calumbin, the alkaloid berberin , and calumbic acid. 
It is used only as a bitter tonic; and by reason of its not containing any 
tannic acid it is frequently combined with iron in the treatment of the sec¬ 
ondary anemias. 




209 


THE STANDARD FAMILY PHYSICIAN 


Calcium 

Cannabis Indica 


CAMPHOR, —A compound obtained from the wood of the camphor- 
tree, Cinnamomum Camphor a, a large evergreen tree growing in China and 
Japan. It is a whitish, translucent substance, having a peculiar strong odor 
and a burning taste. It is very slightly soluble in water, but is easily dis¬ 
solved in alcohol. It is exceedingly combustible, and is so volatile that it 
will entirely disappear if left exposed to the air for any length of time. 
Locally camphor acts as an irritant. Its systemic effect is stimulation of 
the nervous system, and of the heart and respiratory apparatus. An over¬ 
dose irritates the alimentary canal, causing burning pain in the abdomen, 
with nausea, vomiting, and purging. The systemic effect will be shown 
in headache, dizziness, buzzing in the ears, and excitement, followed by 
delirium and convulsions. The patient may be brought into a state of col¬ 
lapse, with a weak, running pulse, shallow respirations, and cold, clammy 
skin. Fatal poisoning by camphor is, however, very rare. 

Camphor is used externally in the form of a liniment for bruises and 
sprains, or to relieve the pain and stiffness of rheumatic joints. Internally 
it is commonly used in cases of nervous depression, headache, and painful 
menstruation. It is a valuable remedy in hiccup. If taken in the early 
stages of a cold in the head, camphor will give much relief, and may even 
abort the attack. It is sometimes used in intestinal flatulence and diarrhea. 
Spirits of camphor is given in doses of about 20 drops. 

CANCER (CARCINOMA).— See Tumor. 

CANNABIS INDICA (INDIAN HEMP). —The flowering tops of the fe¬ 
male plant, Cannabis sativa , indigenous to tropical climates, but largely 
obtained from India and Egypt. This drug has a peculiar effect on the 
nervous system, and for centuries past it has been largely used as an intoxi¬ 
cant in parts of Asia and Africa. It is either smoked or drunk or eaten as a 
confection (the hashish of Monte Cristo). The active principle is contained 
in the resinous substance termed cannabin . 

The effects of the drug vary considerably in the various individuals 
taking it. After a large dose there is usually a period of exhilaration, dur¬ 
ing which the individual feels unaccountably happy and is impelled to do 
and say foolish things. He may have visions of extravagant splendor, per¬ 
haps colored by sensual impressions, particularly if he is of an impression¬ 
able temperament, and the scope of his imagination knows no bounds. 
At other times these hallucinations are of a depressing natuie, or such as 
to inspire him with fear and horror. He does not become unconscious, 
and usually recognizes the unreal character of his dreams. A peculiai 
characteristic of this condition is the loss of the sense of space and time, so 
that minutes seem hours and hours weeks, the clock ticking at absurdly long 
intervals. This is probably caused by the tremendous activity of the mind, 
thoughts flashing along through consciousness with great rapidity, but 
with little or no sequence. Power to appreciate pain is lessened 01 lost. 




Cantharides 
Castor-Oil 


THE STANDARD FAMILY PHYSICIAN 


210 


Periods of unconsciousness supervene, during which the patient may be 
aroused; and he finally falls into a deep sleep, upon awakening from which 
he often feels some nausea and malaise, similar to the symptoms which fol¬ 
low indulgence in opium and most of the other narcotics. This sleep may 
occur without any preceding excitement or unusual sensations. The im¬ 
mediate effect of the drug is not deleterious, but its prolonged use causes 
dementia. Cannabis Indica is used as a sleep-producing remedy in nerv¬ 
ous exhaustion or in sleeplessness due to pain. The dose of the tincture 
is about twenty drops. 

CANTHARIDES (SPANISH FLY). —A beetle, the Cantharis vesicatoria , 
which is found in southern Europe. It is a violent irritant, and is princi¬ 
pally used externally to produce a blister. Internally it is sometimes used 
for its stimulating effect on the urinary tract, but it is uncertain and dan¬ 
gerous. Poisoning by cantharides causes nausea and vomiting, violent 
pain in the abdomen and kidney region, and a burning sensation in the 
• bladder and urethra, with frequent and painful attempts to urinate. The 
urine, which is bloody, is at first diminished in amount and finally suppressed. 
Small particles of iridescent wing-sheaths found in the vomit, show con¬ 
clusively the nature of the trouble. 

CARBOLIC ACID POISONING. —A form of acute poisoning caused by 
the ingestion of carbolic acid, either accidentally or with suicidal intent. 
The first symptom is a severe burning of the mucous membranes of the 
mouth, gullet, and stomach, accompanied by excessive pain. This is soon 
followed by headache, nausea and vomiting, faintness and weakness, and 
death in consequence of a gradual paralysis of the heart. The urine is 
brownish, or greenish black. In such cases it is necessary to assist the 
activity of the heart by administering stimulants, such as strong, black 
coffee, Hoffmann’s anodyne, etc. As antidote, water with the white of eggs, 
milk, a solution of Glauber’s salt, or alcoholic drinks should be given. 
Attempts should be made at once to dilute the acid by copious drafts of 
water which should be immediately washed out or vomited. A physician 
should be called promptly. Carbolic acid ( phenol ) leaves a telltale white 
scar on the mucous membranes, and this, together with the characteristic 
odor, is usually sufficient to make a diagnosis. 

Continued action on the skin of unnecessarily strong solutions of car¬ 
bolic acid, as occurs in frequent applications of carbolic acid compresses, 
may eventually lead to mortification of the skin and of the parts immediately 
beneath it. A solution containing only 2 per cent, of the acid may cause 
this. The skin turns first white, and then black; and sometimes the fingers 
mortify after such carbolic acid bandages. Great care is necessary, there¬ 
fore, in the application of the latter, especially when the solution of carbolic 
acid is not fresh. It is better to avoid them entirely and, until the physician 
arrives, to use less harmful remedies which show equally good results; 




211 


THE STANDARD FAMILY PHYSICIAN 


Cantharides 

Castor-Oil 


for instance, hot water, lead-water, or a 5 to 10 per cent, solution of boric 
acid. 

A number of compounds widely used in the household and in medicine 
contain carbolic acid, and poisoning by them induces similar symptoms. 
Thus creosote, lysol, salol, resorcin, hydroquinone, and guaiacol should be 
included in this group. 

CARBUNCLE. —A loose, general term which may mean one of several 
affections. A benign carbuncle arises from a neglected pimple or furuncle, 
or from several furuncles or small boils. Malignant carbuncles occur as a 
result of diabetes mellitus, or as infections from the micro-organisms of 
anthrax. The favorite sites of carbuncles are the neck and the region of 
the hip. The skin affected by a carbuncle becomes red, painful, thick, 
shining, and swollen. In the center of the globular swelling, which may be 
from 2 to 3 or 4 inches wide, it becomes black and gangrenous; that is, 
it begins to break down, and shows sieve-like perforations of the skin. 

As the disease may lead to grave sickness, or even cause death, time 
should not be wasted with plasters, cold-water compresses, etc., but a phy¬ 
sician should at once be consulted. Cure is brought about only by making 
a large incision, causing relaxation of the inflamed tissue, and facilitating 
the throwing off of gangrenous parts, which in turn are replaced by new 
tissue. See also Furuncle. 

CARIES. —See Bone, Inflammation of. 

CASCARA SAGRADA. —The bark of Rhamnus Purshiana , a tree which 
grows extensively in the western part of the United States, notably in Ore¬ 
gon and Washington. It is widely employed as a laxative and cathartic, 
owing these properties to a purgative resin which it contains. This resin is 
a complex body, largely composed of anthracenes. Cascara used internally 
is a mild bitter, stimulating the saliva and digestive functions. By reason 
of its irritant action on the intestine it causes increased peristalsis and cathar¬ 
sis. It is particularly valuable in chronic constipation, as it may be taken 
for a considerable length of time without impairing the motor functions of 
the intestine. It should not be confounded with proprietary remedies of a 
similar name. See Constipation. 

CASTOR-OIL. —A fixed oil which is expressed from the seed of Ricinus 
communis , or the castor-oil plant, a native of the tropics but extensively 
introduced throughout the world. The oil is a thick, clear, viscid, color¬ 
less and odorless substance. It is widely used in medicine as a cathartic. 
It owes its efficacy to a fatty acid (ricinoleic acid) which is produced by the 
action of the alkaline intestinal juices. This acid is an iiritant, and causes a 
stimulation of peristalsis which results in catharsis. Castor-oil works very 
slowly, six to eight hours, and has the advantage of thoroughly emptying 
the bowel. Thus it is particularly useful in children or adults, in those dis¬ 
orders in which there is excessive fermentation and putrefaction of the 





Castration. 

Catarrh. 


THE STANDARD FAMILY PHYSICIAN 


212 


intestinal contents. It is used in doses of from half a teaspoonful to a table- 
spoonful, depending on the size and age of the patient. Very small doses 
of castor-oil are of service also in the treatment of chronic diarrhea. The 
after-tendency to constipation following the use of castor-oil should be borne 
in mind. It has little food value when rubbed on the skin. 

CASTRATION, FEMALE. —An operation consisting in the removal of 
the healthy ovaries. During the “seventies” of the nineteenth century it 
was frequently performed to treat certain nervous or mental disorders in 
which attacks of excitement or convulsions occurred, especially during the 
time of menstruation, which is an ovarian function. Owing to the un¬ 
certainty of the result, however, this operation has been abandoned except 
in extreme cases. It is now rarely resorted to even in cases of fibroid 
tumors of the womb; instead, the tumor itself is removed, as occasionally 
the “shrinking” of fibroid tumors fails to take place after castration. 
Castration is, however, sometimes considered in cases of absence of the 
womb, when the ovaries give rise to violent pains at the time of menstrua- 
tion. See Ovaries, Diseases of; Ovariotomy. 

CATALEPSY.— A condition occurring in nervous and in mentally de¬ 
ranged persons, and characterized by a peculiar straining of the muscles 
with the assumption of striking attitudes. There are two main forms of 
this disease, known respectively as catalepsy proper and katatonia. 

In catalepsy the muscular rigidity appears generally without warning. 
The patient remains in the position in which he happens to be when the 
attack seizes him. This is accompanied by the remarkable symptom called 
flexibilitas cerea (wax-like flexibility), described below, and by decreased 
consciousness. The attack disappears after a time, but it may under some 
circumstances recur. Cataleptic rigidity of the limbs is most frequently 
observed in hysterical conditions, and also in certain mental derangements. 
In suggestible individuals it can be produced by hypnotism. The treatment 
varies with the cause. Stress should be laid on the fact that there is never 
any immediate danger to the patient, and therefore little cause for alarm. 

Cataleptic states are found very frequently in patients suffering from 
a form of mental disease called katatonia (Dementia praecox). The posi¬ 
tion and movements of the patient become stiff and rigid as though he were 
bound. The entire behavior suggests a wooden and automatic image. At 
times patients will remain in certain positions for weeks, months, and even 
for years, lying in bed with the head bent, face contorted, the lips drawn 
together, the eyes closed, arms bent, and the legs outstretched or drawn up 
to the body. They neither eat nor speak, and they soil their bedding, and 
strongly resist any outside influence. Their muscles feel hard as iron, and 
their limbs can not be moved without using great force; when left alone they 
relax into the old position. There are some patients who allow their limbs 
to be moved, and these let them remain like soft lead in any given position, 







213 


THE STANDARD FAMILY PHYSICIAN 


Castration 

Catarrh. 


even an uncomfortable one, for a long time. Katatonic cataleptics may 
show a like uniformity in their behavior and habits. They will perform 
repeated gyrations for hours, will fall down 40 to 50 times a day and get up 
again, will trot around in a circle like a horse in a circus, will repeat inces¬ 
santly the same foolish words or high-sounding phrases, will dance, trip 
about, giggle, etc.; in short, they manifest a conspicuous, artificial, clownish 
behavior. This condition is at times interrupted by sudden passing periods 
of excitation, accompanied by senseless howling and acts of violence. It is 
remarkable that memory and understanding remain fairly well preserved. 

This disease occurs in both sexes, particularly about the time of puberty, 
and generally terminates in more or less mental debility, interrupted by 
occasional periods of apparent improvement. Such patients are best treated 
in a sanitarium. . 

CATARACT. —A term principally applied to gray cataract, a disease in 
which the pupil appears white or grayish instead of the normal black. It 
is caused by a loss of transparency of the crystalline lens, due to changes 
either in that structure or in its capsule. As a consequence the sight 
becomes impaired, sometimes advancing to the stage in which light can 
hardly be distinguished from darkness. The disease may occur in children 
and young persons; but the most common form is the senile cataract which 
occurs after the fiftieth year. It begins with fine ray-like radiations in the 
lens, and increases gradually until the entire lens is colored gray. The de¬ 
velopment is usually slow, and may progress for years. Usually both eyes 
are affected. 

There is no medical treatment for cataract. All advices of quacks are 
fraudulent. The only remedy is removal of the lens by operation. In 
ancient times and in the middle ages, the cataract was pierced with a needle, 
and the lens couched into the back part of the eye. As internal inflam¬ 
mation resulted, causing the eye to become totally useless, this method was 
dropped. At the present time operations for senile cataract are performed 
with great ease and skill, the translucent lens being removed from the eye 
by making an incision through the cornea. In patients with complicating 
diseases, notably diabetes, a successful outcome is not always assured. In 
children it is well not to delay the operation, in order that the operated eye 
may early become accustomed to seeing without the lens. 

CATARRH.— A disease characterized by simple inflammation of a 
mucous membrane. Used without any specific qualification, the term is 
generally understood as referring to nasal catarrh (see Coryza;. For 
catarrhal affections of other organs, see under Bladder, Diseases of , 
Bronchitis; Cholera Infantum; Eye, Diseases of; Hay-Fever; In¬ 
fluenza; Intestines, Diseases of; Kidneys, Diseases of; Larynx, 
Diseases of; Pharynx, Catarrh of: Stomach, Diseases of; Vagina, 
Diseases of; Womb, Diseases of. 




Catheterism 

Chancre 


THE STANDARD FAMILY PHYSICIAN 


214 


CATHETERISM.— The procedure of emptying the bladder with the aid 
of certain instruments (catheters) especially made for this purpose. They 
are made either of metal (German silver, silver, or tin), or of varnished silk- 
weave, or of red, soft rubber. The catheter is employed either to empty the 
overfilled bladder (in retention of urine) or for purposes of diagnosis and 
treatment (washing the bladder). Catheterism, as well as the introduction 
of other instruments into the urethra, should be done only under certain 
conditions on which the physician should decide. There is always a danger 
that bacteria may be introduced into the bladder with the instrument, 
causing an infection which may give rise to cystitis, or catarrh of the bladder. 
It should also be considered that a clumsy and forcible introduction of the 
catheter may injure the urethra, or cause abrasions of the mucous membrane 
of the bladder, which may lead to disagreeable consequences. 

In general, a catheter should be passed only by a physician. If its 
application is left to the patient, as is sometimes necessary, the following 
general rules should be borne in mind. Only the soft rubber catheters 
should be used; hard instruments are in no way suitable for self-use. Be¬ 
fore using the rubber catheter, which is made entirely from raw caoutchouc, 
it should be carefully examined with reference to its durability. Old cath¬ 
eters that have been in stock for some time become brittle, and it may hap¬ 
pen that a fragment may break off to remain in the urethra or in the bladder. 
The disinfection of these instruments before and after use is of the greatest 
importance. Before use they should be placed in a i :iooo solution of 
silver nitrate or a i :2ooo solution of corrosive sublimate, and then greased 
with liquid paraffin. After use, the instrument should be cleansed with hot 
soap-water, and then rinsed and immersed in a i :iooo solution of corrosive 
sublimate, whereafter it should be put into a jar that can be sealed. 

Before introducing the catheter it is advisable to thoroughly cleanse the 
glans penis, the prepuce, and the opening of the urethra, by first washing 
these parts with soap and then rinsing them with a saturated solution of 
boric acid. It is of the utmost importance that the hands of the person who 
introduces the catheter should be thoroughly cleansed and disinfected (see 
Disinfection). Upon removal of the catheter, the outer opening of the 
instrument should be closed with a finger, or the end of the soft catheter 
compressed in order to prevent the entrance of air into the urethra. If all 
these directions are borne in mind, self-catheterism, which is so necessary 
to many patients (for instance, in swelling of the prostate gland of the aged), 
may do little harm. Carelessness in following out these measures, which is 
so very apt to become prevalent in frequent practise of self-catheterism, 
is usually followed by death in from two to three years. 

CELLULITIS. —A septic inflammation of the cellular tissues. The skin 
is connected with the underlying organs and tissue-strata by loose, cellular 
tissue. In consequence of its loose structure an inflammation may easily 





215 


THE STANDARD FAMILY PHYSICIAN 


Catheterism 

Chancre 


develop and spread. The skin is exposed to innumerable injuries, and as 
a result these cellular inflammations below the skin are of frequent occur¬ 
rence, especially on the fingers, where they give rise to so-called felons. The 
symptoms are heat, redness, and throbbing pain. The infected region 
swells, and also the neighboring lymph-nodes become swollen and sore. 
Even lymph-nodes at a distance may become painful. In severe infections 
the chain of lymphatics leading to and from the site of infection may also 
show reddish and swollen. It is advisable, as a general thing, to have an 
incision made as early as possible, so that the pus will not invade the deeper 
tissues and cause a dangerous extension of the inflammation. 

CEREALS. —The important cereals are wheat, rye, barley, oats, buck¬ 
wheat, Indian corn, and rice. All these products are distinguished in that 
they most favorably combine the principal nutritive elements needed by 
man, namely carbohydrates and proteids; in that they are rich in nutritive 
salts; and in that they are inexpensive, and therefore within the reach of 
every one. As stated in the article on Bread, those cells of the wheat- 
grain that are richest in proteids are arranged near the external covering of 
each individual grain, whereas the starch-cells (carbohydrate cells) occupy 
the center of the grain. Grits, whole wheat, hulled oats, rice, and barley 
furnish very wholesome porridges and soups. 

In spite of the high nutritive value of the different varieties of cereals, a 
nutrition based exclusively upon them is not advisable. The fact that in 
Asia many millions of human beings live on little but rice, while performing 
the severest kind of manual labor, can not be considered determining for 
entirely different racial qualities and modes of living. Aside from the fact 
that only a part of the vegetable albumen of cereals is utilized in the body, 
whereas another, although smaller, part leaves it without having been used 
at all, an exclusive bread-diet is not without some danger to the organism. 
It may give rise to general affections of the bones, especially during the 
period of development, as well as to diseases of the stomach and intestine. 
These disadvantages become most manifest in individuals with mental occu¬ 
pations, whereas manual laborers, owing to their plentiful exercise and 
active metabolism, suffer less from these consequences. Bread, as well as 
porridges and soups made from cereals, are, however, of prime importance 
as popular foods. These foods have the faculty, in combination with fruit, 
vegetables, and small quantities of meat, of preserving the full working- 
capacity without endangering health. In preparing cereals it is of impor¬ 
tance to cook them well, as this will make them much easier of digestion. 

CEREBELLUM.— See Introductory Chapters (p. 66). 

CEREBROSPINAL MENINGITIS.— See Meningitis. 

CHANCRE. —A preliminary eruption in two distinct diseases, and char¬ 
acterized as hard chancre and soft chancre. Eoi haid chanci c, sec \ enereal 
Disease; for soft chancre, see Chancroid. 



Chancroid 

Cheese 


THE STANDARD FAMILY PHYSICIAN 


216 


CHANCROID (SOFT CHANCRE).— A wide-spread, infectious, sexual 
disease, to be distinguished from hard chancre, or syphilis. It is a com¬ 
paratively mild affection inasmuch as its duration is limited; permanent 
cure may always be expected, and a general infection is not associated with 
the essentially local disorder. In most cases of soft chancre, a spreading of 
the process takes place by way of the lymph-channels to the neighboring 
lymph-glands, leading to the formation of painful buboes which often sup¬ 
purate and then again become chancrous (see Bubo). The infection is 
brought about almost exclusively by sexual intercourse, when an existing 
injury of the skin or of the mucous membrane, or one ever so small occurring 
during the act, comes in contact with the secretion of a soft chancre existing 
in the other person. The cause of the affection is probably known (Ducrey’s 
bacillus). 

Soft chancre appears 24 to 48 hours after infection in the form of a minute 
pustule or pimple, which soon broadens and breaks down, developing into 
an ulcer. This ulcer usually extends into the deeper layers of the infected 
site, with finely serrated and often undermined borders. The base of the 
ulcer is covered with a dirty, yellow membrane which appears as if pierced 
by worms; the ulcer which spreads rapidly, assuming the most various 
forms, is very painful to the touch. Proliferations occasionally form upon 
the ulcer, projecting like molds over the surrounding tissue. In other 
cases the rapid spread of the ulcer is combined with gangrenous disintegra¬ 
tion (,gangrenous chancre ); or a refractoriness in healing manifests itself 
even after the chancre has been present for only a brief time. Uncleanliness 
often causes a spreading of the poison, leading to the formation of several 
new ulcers in the immediate or more remote neighborhood of the primary 
chancre. The favorite sites of the affection are the frenum and the lateral 
pouches of the internal leaf of the prepuce beside the frenum. Complete 
destruction of the latter sometimes leads to considerable hemorrhage. After 
several (sometimes 6 to 8) weeks, the ulcer usually begins to become cleaner, 
ultimately healing completely with the formation of a scar. 

Any pustule appearing upon the genital organ a few days after a dubious 
sexual intercourse is suspicious, and requires examination and treatment by 
a physician. Until the latter has inspected the sore, it is advisable to keep 
quiet, observe scrupulous cleanliness, and apply antiseptic cotton and a 
cooling compress. Earliest possible treatment by a physician may essen¬ 
tially shorten the course of the affection; it may cause rapid recovery and 
may thereby prevent the disagreeable consequences of an inflammation of 
the lymph-glands. With the increasing knowledge among all classes of 
people of the importance of cleanliness, the forms of gangrenous chancre, 
which lead to considerable disturbances and destructions, have become 
very rare. 

In order to prevent this affection it is essential to avoid exposure to 





217 


THE STANDARD FAMILY PHYSICIAN 


Chancroid 

Cheese 


danger if there is present the slightest injury of the skin or of the mucous 
membranes of the genital organs. A small abrasion, a blister, or an inflam¬ 
mation, be it ever so small, of the glans of the penis, may serve as the portal 
of entrance for the poison. The only safe method to avoid this as well as 
other venereal diseases is to abstain from all illegal intercourse. 

CHEESE. —An exceedingly important foodstuff which combines cheap¬ 
ness with great nutritive value. Its bad reputation of being indigestible is 
largely due to the foolish habit of swallowing it without chewing it and 
breaking it into small pieces. Cheese may be called pure milk-extract. 
This is absolutely true of cream-cheese, which is obtained from unskimmed 
milk and which, therefore, contains the fat of the latter; it is true to a lesser 
degree of skim-milk cheese, in the manufacture of which partly or completely 
skimmed milk is used. Milk contains an average of 89 per cent, of water; 
and after the loss of this water and of some salts, cheese represents the actual 
nutritive constituents of milk. It must, therefore, be placed in the front 
rank of foodstuffs for the healthy as well as for the sick; especially as 
cheese, if properly masticated, or grated in Italian style and stirred into 
soups, does not make any increased demands upon the digestive organs. 
Soups which contain flour, and those prepared from grain products (groats, 
rice, farina, etc.) can be easily improved in taste as well as in nutritive 
value by the addition of grated cheese. Such food is especially to be recom¬ 
mended for children and weak individuals. 

The epicure, it is true, demands different qualities of cheese; he insists 
that it should be ripened by special bacteria, whereby digestion is relieved 
of part of its labor; and he prefers cheese which has been rendered more 
palatable by molds—for instance Roquefort, Stilton, and Gorgonzola, which 
are profusely streaked with the green swards of molds, such as are found 
also on old bread. In addition to the green molds there occur also red ones 
(likewise harmless) on the surface of certain kinds of cheese; whereas the 
varieties of bacteria that ripen the cheese are much more numerous. As 
these are of importance to the taste, a more exact knowledge of them will 
some day contribute greatly to improve the manufacture of cheese. In 
some varieties of cheese (as Swiss cheese) the bacteria manifest their pres¬ 
ence by the formation of holes, due to the decomposition of milk-sugar with 
the development of gas. 

Hard cheese owes this quality in part to the abundance of phosphorated 
lime which it contains, and which is almost entirely absent in soft cheese. 
White cheese, or whey-cheese, differs from all others in that it is made from 
sour milk, whereas other kinds of cheese are made from milk which has 
been curdled by the addition of rennet. The following varieties of cheese 
may be mentioned: Skim-milk: Parmesan and Liptau; Medium cream. 
Edam, Emmenthal (Swiss), and Cheshire; cream: Limburger, Roquefort, 
and Brie. The average composition of cheese is 25 to 30 per cent, of proteids, 





Chenopodium 

Chicken-Pox 


THE STANDARD FAMILY PHYSICIAN 


218 


8 to io per cent, of fat, and 3 to 5 per cent, of milk-sugar. Artificial cheese 
prepared from oleomargarin is not to be recommended. 

CHENOPODIUM (WORMSEED). —The seed of the Chenopodium an- 
thelminticum, a rank weed which grows about the cities and towns of the 
United States. The seeds are about the size of a pin-head, of a light brown 
color, and have a disagreeable odor and taste. The powdered seed, used 
in ten to twenty grain doses, is a very good remedy for roundworms in 
children. The oil of wormseed is also used. The child should fast for about 
twelve hours before taking the drug, which should be followed by a purge. 

CHEST, DROPSY OF. —A disorder caused by an exudation of blood- 
serum into the pleural cavity. In contrast to pleurisy with effusion, there 
is no inflammatory process present in the pleura in this condition. This 
process is merely a part of a generalized dropsy, and is an accompanying 
symptom of some severe disorder, as diseases of the heart or of the lungs, 
cancer, chronic Bright’s disease, leucocythemia, dysentery, or of cachexia 
due to syphilis or to malaria. The recognition of the disease demands a 
very careful physical examination, in order to exclude a wet pleurisy on the 
one hand, and to discover the underlying disease on the other. 

The essential effects of a collection of fluid in the pleural cavity are to 
cause marked pressure on the lungs and to displace the heart. Pressure 
on the lungs makes respiration more difficult, and a dyspnoeic condition may 
be brought about. The skin assumes a bluish tinge on account of the 
abnormal quantity of carbonic acid in the blood, and the pulse becomes 
small and rapid. Treatment must be directed to the underlying disease, 
so that no general indications can here be formulated. The accumulation 
of the fluid itself is only made a subject for attack in case its volume is so 
great as to lead to a possible danger from asphyxiation. When this is the 
case, aspiration of the contained fluid is indicated, which, if skilfully exe¬ 
cuted by a practised hand, is an almost harmless procedure. 

CHEST, PAINS IN. —The lung has so little sensitiveness that even exten¬ 
sive destruction of its tissue may take place without producing the least 
amount of pain. The distressing symptoms to which this name is given 
come from the pleura, the thoracic muscles, the ribs, or from the intercostal 
nerves. 

Pain as the result of irritation or inflammation of the pleura is very fre¬ 
quent, and in the early stages of a pleurisy it constitutes the most significant 
and distressing symptom. If, after the inflammatory process has subsided, 
adhesions are left between the pleura covering the lungs and that covering 
the ribs, sensations are produced which are annoying and even painful. 
This is due to the tearing action to which the bands are subjected by the 
movements necessitated by the respiratory act. 

The pain which results from any affection of the ribs is increased by 
pressure over the diseased area. This is also true in fracture of the ribs, 




219 


THE STANDARD FAMILY PHYSICIAN 


Chenopodium 

Chicken-Pox 


and here the condition may furthermore be recognized by the crepitation 
which is produced when the broken ends of the bones are rubbed together 
by the fingers of the examiner. Contusion of the soft parts of the chest, 
caused by a fall or a blow, is also accompanied by pain. In other cases, 
pain in the intercostal muscles may be due to rheumatism, or to a neuralgia 
of the intercostal nerves. The latter affection is seen more often in women 
than in men, and the pain is localized along one or more of the intercostal 
spaces corresponding to the affected nerves, or it may be more severe at 
certain points than at others. 

The treatment of pain in the chest must be merely local, but must be 
governed entirely by the cause as determined by a most careful examination. 
In all cases rest (preferably in bed) must be insisted upon, because motion 
and deep respirations always aggravate the pain. 'If medical assistance 
can not be had at once, hot applications to the back and chest will afford a 
great deal of relief. A faulty position of the body will undoubtedly bring on 
pain in the chest, and this is a fact which is not fully appreciated. Persons 
who follow sedentary occupations should be cautioned to sit straight; and 
at frequent intervals, if only for a few minutes at a time, they ought to get 
up and, with arms outstretched, take a few, deep, long breaths. 

CHICKEN-POX. —A contagious, febrile disease of children, character¬ 
ized by eruptions of scattered vesicles. It attacks most children, leaving 
them immune against the contagion afterward. The disease-symptoms 
appear 13 to 17 days after infection. The patients feel sick, have moderate 
fever, headache, some dread of light, and loss of appetite. During the 
course of the 2 to 3 days of fever, a rash appears, especially over the trunk 
and head, also in the face, less frequently on the limbs. At first this rash is 
punctiform, and develops rapidly into papulae and vesicles. The vesicles 
are isolated, and are surrounded by a reddened zone; they dry quickly 
and generally scab over without leaving a permanent visible scar. The 
rash itches considerably, and is frequently scratched, which at times causes 
it to become ulcerated. In such cases it heals as a scar. In children with 
unhealthy skin, the eruption may assume a serious ulcerative character. 

Parents are advised to keep the children in bed, at least until the rash 
has dried, but not to keep them too warm. The sick-room must be venti¬ 
lated frequently. The itching sensation is considerably eased by washing 
with lukewarm water and powdering with antiseptic powders. In appear¬ 
ance, chicken-pox resemble the mild forms of smallpox, which, however, is 
a totally different disease; recovery from chicken-pox does not make the 
patient immune from smallpox, and vice versa. It is highly important 
always to consult a physician, as many cases of smallpox have been taken 
for chicken-pox and serious epidemics arisen. Although chicken-pox is a 
very mild affection, it is an unnecessary one. Patients should be isolated 
and great care exercised to prevent the spread of the infection. 






Chilblains 

Childbed 


TIIE STANDARD FAMILY PHYSICIAN 


220 


CHILBLAINS.— Flat or nodular swellings and elevations, which at the 
onset itch greatly, and are often very painful. They are due to paralyses 
and dilatations of the blood-vessels, resulting from a disturbance of the 
circulation of blood in the skin under the influence of low temperatures. 
Chilblains develop especially on projecting parts of the body, such as the 
nose, ears, fingers, toes, and knuckles. They cause the affected parts to 
lose their pliability; the heavy, irregular bruises become bluish, red, smooth, 
and glistening (as if varnished), and sometimes the foimation of moist 
vesicles is noted. A continued disturbance of circulation gives rise to sores, 
fissures, and crusts, from which ulcers may develop. It is a mistake to 
believe that chilblains can appear only when the temperature is below the 
freezing-point, as they may arise also without frost; for instance, as a 
result of frequent washing in cold water. Deficient circulation of the blood 
favors their formation in such instances. 

To prevent chilblains it is necessary to keep as warm as possible. Any 
one with a tendency to cold hands and toes must not fail, in winter, to 
encourage the circulation of the blood by frequently bathing hands and 
feet in hot and in cold water alternatingly. This will tend to strengthen 
the muscles of the blood-vessel walls, the relaxation and numbness of which 
cause chilblains. Any one suffering from cold feet should wear wide, 
comfortable shoes, and in winter thick, woolen stockings which extend 
above the knees (so-called hunting-stockings). Experience teaches that 
such stockings furnish the best protection. Pulse-warmers (wristlets) and 
mittens are better than the usual gloves, as the latter do not prevent the 
occurrence of chilblains. Persons prone to this affection in certain parts of 
the body should rub these parts several times a day with a piece of pure 
camphor, such as may be obtained in any drug-store. After chilblains have 
developed, a io per cent, camphorated collodion should be painted on the 
affected parts with a brush. Remember that collodion is very inflammable. 

CHILD, CARE OF THE. — See Health-Care of Children. 

CHILDBED. —In a limited sense childbed embraces the time needed 
for the healing of the wounds of the internal generative organs, caused by 
childbirth; in a broader sense it embraces the time needed for the complete 
involution of the pelvic and abdominal organs, which generally takes six 
weeks. After this space of time the first menstrual period begins, unless 
delayed by nursing, which happens in the large majority of cases. 

As in the case of other wounds, not neglected nor infected, the wounds 
caused by childbirth heal without fever or material pains. After child¬ 
birth the woman is exhausted from the exertion attendant thereon, and 
needs rest; and this being necessary for quite a long time, it is important 
to lay her in a clean and comfortable manner. The duration of childbed of 
a healthy woman may last in some cases only a few days, while in others it 
may take from three to four weeks. The former is too short a period for 






221 


THE STANDARD FAMILY PHYSICIAN 


Chilblains 

Childbed 


most women, and the latter too long, causing relaxation; 9 to 12 days is the 
best average time. At the beginning, the woman should lie on her back; 
later, on her side. The mattress must be protected by a rubber sheet, 4 
feet square, covered by a sheet in which to take up the discharges; over this 
another folded linen-cloth should be drawn across the bed, under the sacrum. 
The bedding must be absolutely clean and dry. The lochial discharge is 
caught in gauze napkins and should not smell badly. If it is offensive it 
contains foul germs which ought not to occur. During the first few days 
the discharge from the interior of the womb is bloody; then it becomes 
watery until the end of the first week, and then white. If it is bloody for a 
longer time, it is a sign of faulty contraction of the womb. Severe hemor¬ 
rhages are caused by remnants of placenta or by inflammations. Further¬ 
more, there may be abnormal discolorations (like burnt raspberry-jelly); or 
in very severe cases a sudden cessation of the lochia, without changes in the 
odor, may occur. 

The excreta of a confined woman should be taken up in bedpans (Fig. 
101) as she should not leave the bed. The urine should be passed twice 
daily from the very beginning, as the bladder is paralyzed at times and may 
become distended by retention of urine. Women in childbed, who can not 
urinate when lying on the back, may be assisted to sit up in bed, but this 
should be done slowly and carefully. 

There is another advantage in the sit¬ 
ting posture in that the lochial dis¬ 
charge can flow more readily from the 
vagina. It is wise to make attempts 
to urinate while lying on the back, 
before the time of childbirth. Laying 
the hand over the bladder is at times helpful for the patient who can not 
urinate. The paralysis of the,bladder may often be overcome by the ap¬ 
plication of hot towels, by spraying the opening of the urethra, or by the 
use of an enema. If these means are not successful, the practised hand of 



Fig. ioi. Bedpan. 


the nurse or physician must insert a catheter, after disinfection of the mouth 
of the urethra. The catheter should be boiled before use. 

On the third or fourth day after confinement there should be a move¬ 
ment of the bowels, and this may be furthered every third day by adminis¬ 
tering a dessert-spoonful of castor-oil, or by enemas. To oveicome the 
intestinal inertia the patient should take cooked fruit, fresh \cgetables, a 
predominantly liquid diet, Graham bread, honey, and butter. I he enemas 
must measure about a quart (not much more), to which may be added a 
teaspoonful of cooking-salt, five tablespoonfuls of salad-oil, or a piece of 
glycerine-soap the size of a walnut. If there is flatulence, peppermint and 
fennel tea may be given in addition to the enemas. After each evacuation 
of the bladder and of the intestine, the external genitals must be washed 







Childbed 


THE STANDARD FAMILY PHYSICIAN 


222 


clean and sprayed. Sponges must not be used for this purpose as they are 
never free from disease-germs; but absorbent cotton or sterile gauze should 
be used in their place. For disinfecting the genital organs, creosol (£ tea¬ 
spoonful stirred well into two quarts of boiled water) or lysol (one part to 
ioo of water) may be used. These directions also hold good in cases of 
miscarriage or of premature birth, and the various necessaries should there¬ 
fore be in readiness before the time of expected confinement; the infant’s 
clothes need not be ready before the eighth month. Clean water is not nec¬ 
essarily free from germs, and therefore must not be used for washing the 
genitals before it has been boiled. The addition of a disinfectant is not as 
effectual as boiling. The sacral region must be kept very clean, and if 
necessary it must be treated with vinegar-water or with a desiccating powder, 
so that the patient will not get sore. If this condition does occur, zinc- 
salve should be applied to the part, and an air-cushion placed under the 
patient. Generally, bodily cleansing is necessary once or twice daily, and 
is effected by a lukewarm bath of the entire body, including the back and 
the sacrum. The additional treatment of the skin for the restoration of 
elasticity may be effected by abdominal massage, which must be given only 
by a practised hand, and only in cases which are free from fever. The 
massage-treatment also tends to stimulate the circulation of the blood in 
the mammary glands, and to encourage the flow of milk. 

For the prevention of pendulous abdomen, the abdomen is laced. The 
relaxation of the abdominal walls causes the intestines to become inflated, 
and the blood- and lymph-vessels in the suspensory ligaments of the organs 
to become abnormally distended with fluid, which causes them to relax. 
When the patient gets up all the organs sink, giving rise to floating kidney, 
gastroptosis (falling of the stomach), and flatulence, as well as to retro¬ 
flexion, prolapse, and catarrh of the womb. After evacuation of the bladder 
and intestine, and after the abdominal massage, two towels should be placed 
under the patient below the sacral region, then drawn firmly over the abdo¬ 
men and hips, and securely fastened together with several safety-pins. The 
abdomen may be compressed also by means of several sheets or by a sand¬ 
bag; this, however, should not be done until it has been laced, since other¬ 
wise it will merely flatten the abdomen. Later on, gymnastic exercises for 
the abdominal muscles may be resorted to as effective remedies for the pre¬ 
vention of pendulous abdomen. 

The diet to be observed during confinement must necessarily be strict 
and simple. This is of importance not only in regard to the return to their 
normal condition of the abdominal walls and organs, but also for certain 
other reasons. Our ancestors knew this well enough, even if they did not 
understand the reasons for, or the limits of, a restricted diet. They rec¬ 
ommended an exclusive liquid diet consisting of milk and paps. Such a 
diet prevented digestive disturbances, promoted the secretion of milk, and 





223 


THE STANDARD FAMILY PHYSICIAN 


Childbed 


assisted perspiration. There was great need of such a procedure in former 
pre-antiseptic times, on account of the frequent occurrence of puerperal 
fever. It is imperative to avoid digestive disturbances; not because they 
may be the cause of puerperal fever, but because such disturbances readily 
occur during confinement, and interfere with the proper involution of the 
pelvi-abdominal viscera and with the secretion of milk. Taking into con¬ 
sideration the fact that the diet should be easily digestible, and remembering 
its effect on the secretion of milk, the following dietary is advisable in cases 
of confinement: During the first three days liquid food only should be given, 
particularly milk, sweetened water, cocoa without spices, and eggs; a small 
quantity of zwieback or dry toast may be added. From the fourth to the 
sixth day (if the bowels have moved) the diet may include also some white 
meat, the sweetbread or brains of calves, squabs, white bread, and stewed 
fruits. After the seventh day beef (roasted, broiled, or smoked), ham, 
vegetables easy of digestion, and light puddings may be eaten. Spices, alco¬ 
holic drinks, food insufficiently cooked, fat meat or pork, unripe fruits, 
salads, and bread or pastry not readily digestible should be entirely avoided. 

An inclination of the womb to retroflexion, dropping, and prolapse, 
which frequently accompanies a tendency to pendulous abdomen, is also 
best overcome during confinement. For women who are thus afflicted, a 
lateral position is best; but above all else they must be scrupulous about 
emptying the bladder at regular intervals. Apart from the healing of the 
womb, it is necessary that all tears in the perineum should be immediately 
repaired, for experience teaches that otherwise there will be insufficient sup¬ 
port for the generative organs, thus contributing to the causes of sinking and 
prolapse of the womb. The sewed wound must be carefully treated and kept 
clean; otherwise it will not heal. 

The patient’s room should contain only such furniture as is necessary, 
and everything which tends to collect dust should be taken out. The room 
should not be kept dark, and must at all times be well ventilated; heavy 
draperies are, therefore, superfluous or even harmful. Usually the patient 
is confined in her own bedroom. For the sake of good health in geneial, a 
bedroom must never have damp walls, and to avoid this is especiall) im¬ 
portant in cases of confinement; in the winter the room should have proper 
heating facilities. No bed which has previously been occupied by a patient 
suffering from an infectious disease should ever be used in a case of confine¬ 
ment, unless everything connected with it has been thoroughly disinfected 
by professional disinfectors. The mattress, especially, should be dry and 
clean. The sheets, pillows, and covers must be clean and perfectly dry, 
and this applies also to the linen worn by the patient. The bedpan, cham¬ 
ber-pot, syringe, etc., must be in faultless condition; the syringe should be 
provided with 4 to 5 feet of rubber-tubing and 2 glass tubes. Near the 
expected time of confinement, it is advisable to give the room a thorough 








Childbirth 

Chloroform 


TIIE STANDARD FAMILY PHYSICIAN 


224 


cleaning in all corners, and to hang new curtains. The floors should be 
scraped and washed with chlorid of lime. A large supply of body-linen, 
bed-linen, and towels should be kept in an accessible and dry place; and 
the nurse or midwife should be shown in good time the arrangement of the 
room and the wardrobes. 

In addition to general bodily hygiene, mental rest is essential to the 
patient during pregnancy and childbirth, as well as during confinement and 
throughout the entire period of nursing. Sudden excitement may cause 
severe hemorrhages and permanent relaxation of the pelvic organs, in con¬ 
sequence of disturbances in the circulation of the blood. The same applies 
to bodily and mental exertions. The proper time for the patient to get up 
depends upon her pulse and temperature, as well as upon the character of 
the lochial discharge (whether bloody or otherwise), and upon her general 
condition. In all cases the family-physician should decide, as in this way 
threatening accidents (as thrombosis, etc.) may be guarded against. It is 
not as burdensome for the patient to take mild exercise, as it is to assume 
the full control of the household; and at least two weeks should elapse 
before taking up these duties. Women who can not get the necessary care 
and attention in their homes ought to go to a lying-in hospital. 

CHILDBIRTH.—See Parturition. 

CHILDLESSNESS.—See Sterility. 

CHILDREN, CARE OF. — See Health-Care of Children. 

CHILLS.—See Malaria. 

CHLORAL.—A compound drug which occurs in whitish or colorless 
transparent masses or in little crystals. It is volatile, quite soluble, and 
has a burning taste. It should be kept in a dark place, tightly corked. 
It is one of the commonest hypnotics, or sleep-producers. Locally, it acts 
as a powerful irritant. When taken internally it depresses all the func¬ 
tions of the body, acting perhaps most powerfully on the nervous system, 
but also depressing the heart and breathing-apparatus. In moderate doses 
the only effect usually seen is what appears to be a deep, normal sleep from 
which the patient can be aroused. After a poisonous dose the sleep is 
deeper and may pass into profound unconsciousness. The pupil of the 
eye becomes dilated; the breathing is shallow and slow; the pulse is rapid 
and irregular, or may disappear altogether; the body is absolutely relaxed; 
and the skin is pale and clammy. In case of an overdose a doctor should 
be summoned at once. While waiting for his arrival, the patient should 
be made to vomit, if possible, by administering large drafts of warm salt 
water, or a couple of tablespoonfuls of mustard-in a glass of water. He 
should be wrapped up warmly in bed with the feet higher than the head, 
and kept awake if possible. The habitual taking of the drug may cause 
mental and physical weakness, palpitation of the heart, shortness of breath, 
or skin eruptions. Chloral is used for any form of sleeplessness not due 






22.5 


THE STANDARD FAMILY PHYSICIAN 


Childbirth 

Chloroform 


to pain, but it is not as safe a drug as several others which are used for the 
same purpose. It is used in combating convulsions, such as in strychnin¬ 
poisoning, or in tetanus. In these conditions it is often necessary to give 
it by rectum. The dose is from five to ten grains, well diluted. 

CHLORATE OF POTASH. —A drug which occurs in small whitish 
plates, having a pearly luster. It is a local irritant, and taken internally 
in large doses it may cause severe symptoms of poisoning, and even death. 
Pain in the head and abdomen, weakness, shortness of breath, and weak, 
running pulse may occur. The stomach should be emptied immediately. 
Combined with other drugs, chlorate of potash is useful as a mouth-wash 
in various forms of inflammation of the mouth. It is used also as a gargle, 
and is given internally for sore throat. As a mouth-wash or gargle it is 
used in a strength of about ten grains to the ounce. The dose internally 
is one or two grains. 

CHLOROFORM. —A clear, colorless liquid with a peculiar sweetish odor 
and a burning taste. It was introduced as an anesthetic in 1847 by Sir 
James Young Simpson, a physician of Edinburgh, a few years after ether had 
first been used for this purpose. By making it possible to perform surgical 
operations without pain to the patient, these drugs broadened the scope of 
surgery almost infinitely, and have proved a priceless gift in prolonging life 
and lightening the burden of suffering humanity. In these days it is almost 
impossible to realize the tortures that had to be endured before the advent of 
anesthesia. Chloroform is administered as an anesthetic by inhalation. 
There are various devices by which this is accomplished, all based on the 
principle of allowing the vapor of a little chloroform, mixed with a plentiful 
supply of air, to be inhaled. It is usually dropped on a gauze or cloth mask 
held over the patient’s nose and mouth. When taken in this way there are 
three indefinite stages of anesthesia noticed. 

During the first stage there may be at first a sense of suffocation. The 
face and head begin to feel warm, there is a buzzing or ringing in the ears, 
and everything seems far away. Sensation is blunted; and this stage is 
sometimes utilized to perform slight operations, or to ease the pains of child¬ 
birth. This condition soon passes into the second stage, that of excite¬ 
ment, which is not unlike alcoholic intoxication. The patient may laugh, 
sing, pray, or swear; and he moves more or less, sometimes struggling 
violently. At this stage the patient is usually entirely unconscious of what 
is going on about him, and is insensible to pain. The third stage is one 
of complete unconsciousness and muscular relaxation. It is at this time 
that the surgeon operates. By careful observation of certain signs, with 
occasional administration of a few drops of chloroform, the patient may 
be kept for hours in a condition favorable for operation, and yet not too 
deeply under the influence of the drug. Upon the withdrawal of the drug 
the patient may pass through a second period of excitement resembling the 





Chocolate 
Cholera Asiatica 


THE STANDARD FAMILY PHYSICIAN 


226 


previous one, but usually less violent. He may be nauseated and vomit, 
whereupon he may go into a peaceful sleep lasting for hours. Chloroform 
is a depressant to the heart, and notwithstanding every precaution a fatal 
accident will occasionally occur—about once in four thousand cases. For 
this reason most American surgeons prefer to use ether, which is considered 
somewhat safer under ordinary circumstances, there being (according to 
Wood) about four times as many deaths from chloroform as from ether. 
Chloroform is less irritating to the kidneys and lungs, and is generally 
chosen in conditions affecting these organs. It is sometimes used to con¬ 
trol violent convulsions. Internally it is given for intestinal colic, ten or fif¬ 
teen drops of the emulsion or spirits being used. Chloroform liniment is a 
familiar remedy for external use in painful muscular affections. 

CHOCOLATE. —A Mexican word originally signifying the beverage pre¬ 
pared from cacao, but now usually designating a combination of sugar, 
spices (vanilla), and the cacao-mass. This preparation is generally placed 
on the market in tablet form, and contains varying proportions of sugar 
and cacao. When large quantities of sugar are present, as in the cheaper 
grades of chocolate, it becomes necessary to add an increased quantity of 
cacao-butter in order to preserve the proper consistency of the mass. For 
these reasons the inferior grades of chocolate are sweeter than the better 
qualities, and contain more fat, unless they have been further adulterated 
by the addition of starch. Chocolate must be regarded as a valuable food, 
saving especially hunters and travelers the inconvenience of carrying bulkier 
food of different grades; it also possesses the advantage over ordinary foods 
of being a stimulant for the fatigued, owing to its contents of theobromin 
(see Cacao). But the nutritive value of chocolate for domestic use should 
not be overrated, since it is greatly limited by the small quantities used, as 
well as by the inferior quality of chocolate often unwittingly purchased. 
It is advisable, therefore, to use milk in the preparation of chocolate for 
invalids and children; and if it is desired to still further increase the nutri¬ 
tive value an egg may be added. 

CHOLERA ASIATICA. —An acute infectious disease, characterized by 
pain, excessive diarrhea, rice-water discharges, and intense collapse. The 
disease is endemic in certain portions of India where it rages most of the 
time, occasionally spreading to other parts of the globe. In the United 
States epidemics of cholera have occurred at irregular intervals from 1832 
to 1873. Since the beginning of the nineteenth century, when the disease 
became more completely recognized, Europe has had six cholera epidemics; 
and local infections, transplanted through shipping, are of frequent occur¬ 
rence. It is a subject of popular belief that a very hot summer, in which 
many people are suffering from diarrheal troubles, has a tendency to bring 
with it an epidemic of cholera. This is, however, an error, as cholera 
neither develops of itself nor is due to other diseases or climatic influences. 





m 


THE STANDARD FAMILY PHYSICIAN 


Chocolate 
Cholera Asiatica 


It can develop only when the infectious materials are transported from 
India and spread about in other localities. 

The germ which causes the disease is a microscopic organism belonging 
to the low group of plants known as bacteria. It was discovered by Robert 
Koch, and is called the comma-bacillus or Spirillum cholera-asiatica. 
Cholera can be caused only by these germs gaining entrance into the intes¬ 
tinal canal; either with the food or drink, or in any other accidental way. 
The germs multiply very fast, and produce toxic substances which are 
absorbed from the gut and give rise to disease-processes in various parts 
of the body. The cholera bacilli are thrown off from the body with the 
evacuations from the bowels; and the patient’s stools and everything else 
which either directly or indirectly comes in contact with him are therefore 
means of spreading the contagion. Dryness kills these germs very quickly, 
however, and they remain infectious only while lodged in or upon objects 
which furnish a sufficient supply of moisture. In addition to the patient 
himself, his clothing, wash, excrements, etc., it is well also to regard water, 
milk, fruit, and other foodstuffs as possible carriers of infection. 

The more careful and thorough the study has been of the manner in 
which the disease has been distributed from its Indian home, the more 
evident it has become that this transmission has followed the lines of travel 
and transportation. The contagion is carried from place to place by 
infected persons, and not by the wind or similar agencies. In order to pro¬ 
tect a country against the invasion, it is necessary to direct the attention to 
individuals coming from an infected port. Formerly all intercourse was 
interrupted with localities in which cholera was raging, and travelers were 
isolated and kept under observation for several weeks before being admitted 
to free intercourse with others. As a matter of fact, however, it was found 
that even these stringent rules accomplished very little. Ways and means 
were usually found to escape the quarantine regulations if an individual 
was very desirous of doing so; and the disadvantages and losses resulting 
from the restrictions placed on trade and intercourse were enormous. In 
later years the protracted quarantine of travelers has been somewhat modi¬ 
fied. Persons coming from infected ports are now allowed to land, but 
their health is carefully watched, and especial care is taken that every 
suspicious case is at once reported to the proper authorities for further 
observation. 

It must not be forgotten that an individual may swallow a certain num¬ 
ber of cholera bacilli without becoming afflicted with a severe attack of the 
disease. Many persons thus infected suffer only a slight diarrheal trouble, 
and others even less in the way of symptoms; yet their stools may serve as 
a source of infection to numerous other, more susceptible people. During 
the prevalence of a cholera epidemic, all cases of diarrhea must be viewed 

and treated with suspicion. 




Cholera Asiatica 
Cholera Infantum 


THE STANDARD FAMILY PHYSICIAN 


228 


The more important precautions to be observed during an epidemic are 
the following: In the first place one must beware of having too great a fear 
of becoming infected. It is an axiom of long experience that fear, as well 
as all other agitated states of the mind, increases the susceptibility of the 
body to the invasion of disease. Even if cholera breaks out in the locality 
where one lives, it is better to remain than to go away, because at home one 
is best able to continue without interruption the usual mode of life and also 
to avoid digestive disturbances which greatly increase the liability to infec¬ 
tion. An attack of diarrhea, however slight, necessitates immediate re¬ 
course to medical advice. 

Articles of diet on which the germs of cholera are usually found, such as 
fresh fruit, vegetables, and milk, should always be thoroughly boiled before 
being eaten, unless their source is free from suspicion. Water which has 
been contaminated by contact with the excreta from cholera patients is 
often the source of infection. For all household purposes, only such water 
should be used which comes from sources of supply known to be uncontam¬ 
inated, and if there is any doubt the best thing to do is to boil it before use. 
During the prevalence of cholera it is best to avoid houses in which the 
disease is known to be present, and also all public meetings and places of 
amusement where many people congregate. Neither is it wise to lodge 
persons in one’s house who have come from infected localities; and all 
articles which have been used by patients must not again be employed 
unless thoroughly disinfected. Public baths and toilets should be avoided. 
Absolutely no value attaches to the numerous proprietary prophylactic 
remedies which regularly appear during a cholera epidemic. They benefit 
no one but their manufacturers and sellers. 

If, in spite of all these precautions, a member of the family is attacked by 
the disease, it is advisable to send the patient to a hospital. Aside from the 
experienced care and attention which is enjoyed, there is the additional 
advantage that all the infected clothing and the excreta can be properly 
disinfected, and that in this manner further contagion can be to a great extent 
avoided. If the patient remains in the house, it is necessary to isolate him 
completely together with his nurse. Extreme cleanliness is one of the most 
essential things. The stools and soiled articles must be disinfected in the 
way prescribed by the physician. During the period of the disease nothing 
must be removed from the sick-chamber. The nurse must not be per¬ 
mitted to take any food or drink while in the patient’s room, and she must 
wash her hands thoroughly every time she has touched the sick person. In 
case of death, the body should be removed from the house as soon as possible, 
placed in the casket without being washed, and buried with little or no 
public ceremony. After either recovery or death, the room should be 
thoroughly disinfected as described in the article on Disinfection. 

It is necessary for the public authorities to consider every inmate of the 






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Vi 


PLATE VI. 

Fig. 1. Left ventricle (opened). Wall thickened by disease, and cavity dilated. 

1. Aorta (opened) 2. Semilunar valves 

3. Mitral or bicuspid valve 

Fig. 2. Thrombus (coagulated blood) in vein. 


0 



f 



Plate VI 














229 


THE STANDARD FAMILY PHYSICIAN 


Cholera Asiatica 
Cholera Infantum 


house in which a case of cholera exists, as capable of carrying infection; 
and it is therefore necessary that they be subjected to certain rules and 
regulations. 

Cholera in its severer forms begins in from twelve hours to five days 
after the reception of the contagion in the intestinal tract. The first symp¬ 
tom may be an apparently harmless diarrhea, gradually succeeded by all 
the other symptoms; or the disease may be marked from the very begin¬ 
ning by severe vomiting and diarrhea. The evacuations become very 
numerous and resemble rice-water or pea-soup. In a few hours the patient 
may become rapidly exhausted from the resulting weakness. The skin is 
dry and cold, and when pinched into a fold it remains thus; the face dis¬ 
plays an expression of suffering; the voice is dull; a burning thirst is felt; 
the quantity of urine steadily diminishes; and painful cramps in the mus¬ 
cles, especially in the calf of the leg, torture the patient greatly. The weak¬ 
ness increases and death ensues. Even when the symptoms improve and 
the patient appears to revive, a favorable prognosis is by no means certain. 
He often succumbs after days or weeks from the consequences of the attack. 
As has already been stated, not all cases of cholera run such a virulent 
course, and many much milder ones occur. Many of the very severe ones 
also end in recovery. 

There are no specific remedies or methods of treatment with which recov¬ 
ery may be assured in the severe cases of cholera. Nevertheless, timely and 
appropriate medical care will do much to diminish the sufferings entailed 
by the disease, and also to sustain the strength of the patient. 

CHOLERA INFANTUM. —The so-called summer-diarrhea, an affliction 
• which carries away many children in their first year of life. It prevails at 
any time from May to October, but most frequently during July and August. 
Excessive heat and high humidity are factors favoring its development. 
Artificially nourished infants are particularly prone to the disease, which is 
unquestionably dependent on changes which the heat produces in the milk. 
Among the immediate causes may be mentioned the presence of pathogenic 
bacteria in milk which is not handled in a cleanly manner, ferments which 
are present in the fodder fed to the cows, overfeeding with milk which con¬ 
tains too much albumin, and too early feeding with gruels. In many cases 
with complicating dysentery, a specific bacterial flora is present, the Bacillus 
shiga being one of the most common representatives. 

The children may be very restless before any definite symptoms of the 
disease appear. They cry pitifully, and constantly draw up their legs over 
the abdomen, which is distended and tender to the touch. After a time the 
stools become green, or consist of mucus streaked with green. In other 
cases the initial symptoms may be eructations and vomiting. The stools 
then increase in frequency, and are thin, green, like rice-water, or mixed 
with mucus. If not already present, vomiting follows. If nothing is done 





Cholera Morbus 
Cinchona 


TIIE STANDARD FAMILY PHYSICIAN 


230 


for these children, they become rapidly weaker from this continued diar¬ 
rhea; the cry becomes hoarse and moaning, the eyes sink in, the nose 
becomes pointed, the fingers cold and blue, the skin dry, and a series of 
convulsions may bring about a fatal ending. If these symptoms appear in 
a child previously well and having normal stools, no time should be lost in 
summoning a physician. In the meanwhile all nourishment must be stopped, 
and the intense thirst may be satisfied with a little boiled water or weak 
tea. If an irrigator is at hand it is well to give the child several enemas of 
lukewarm water. In every case, the soiled napkins should be saved for 
the physician’s inspection, so that he may note the character of the stools. 

CHOLERA MORBUS. —An acute affection of adults or adolescents, 
resulting from indiscretion in diet. It may be due to the quantity, but is 
more often due to the quality and kind of the food. The numerous com¬ 
ponent dishes of a single meal are often, when mixed together in the stom¬ 
ach, the means of generating a disturbance. In the summer there is more 
apt to be trouble from the ingested food than in the winter, because many 
articles of diet are somewhat decomposed as the result of the heat, and 
contain toxic substances. Then again the body is frequently subjected to 
a sudden cooling by iced drinks. Sudden variations of outside temperature 
is an important factor in some people. Among the great variety of dishes 
which may produce these gastro-intestinal disturbances may be mentioned 
fatty food, sausage, cheese, salmon, lobster, mushrooms, pickles, sour milk, 
and unripe fruit. Sometimes the first symptoms of the trouble may be 
noticed immediately after the meal, sometimes not for a few hours or not 
until night. They consist of severe gastric and abdominal pains, fever, 
sometimes chills, vomiting (first of food; later of mucus, water, and bile), 
and of diarrhea which often persists until the stools become watery. The 
patient finally becomes weak and exhausted. The cause of these dis¬ 
turbances is a slight inflammation of the stomach and intestines, which may 
last several days and then entirely disappear. If the condition is neglected, 
however, the catarrh becomes chronic, and results in many cases in more 
or less continual digestive disturbances. One of the noteworthy accom¬ 
paniments of this trouble is extreme thirst, which is due to the marked loss 
of water from the body in the vomitus and stools. The appetite for solid 
food, on the other hand, seems to be entirely lost. The urine is also scanty 
in amount. A loss of several pounds in weight may result in a few days as 
a consequence of one of these attacks. 

The elements of treatment are very simple: rest in bed, and the con¬ 
tinued application of heat to the abdomen. The heat should preferably 
be dry, and may best be applied in the form of hot plates, sand-bags, or hot- 
water bottles. The diet should be fluid and cold, and given in small quan¬ 
tities. The most suitable articles are iced milk and chocolate, tea, cracked 
ice to overcome the nausea, and cold gruels. It may benefit an adult 




231 


THE STANDARD FAMILY PHYSICIAN 


Cholera Morbus 
Cinchona 


patient to abstain entirely from food for twelve hours. It is advisable to 
administer a brisk cathartic at the very first signs of trouble, in order that 
the decomposing food which predisposes to the catarrhal conditions may 
be thoroughly evacuated from the intestinal tract. Castor-oil is usually 
effective. As soon as free evacuations have been secured, the physician 
may administer medicines to again quiet the digestive canal. A moderate 
and carefully chosen diet should then be adhered to for a few days more. 

CHOREA.— See St. Vitus’s Dance. 

CHOROIDITIS. —See Eye, Diseases of. 

CIMICIFUGA. —The root of the black snakeroot, or Cimicijuga race¬ 
mose a plant about six or seven feet in height, growing in damp, shady 
places. It is used most commonly for St. Vitus’s dance in children, acting 
very satisfactorily, especially when given with some preparation of iron, 
and laxatives. Brain-ache is a sign to discontinue its use. Too large doses 
cause dizziness, with severe headache and general prostration. 

CINCHONA. —The bark of a number of trees growing naturally in the 
northern and western parts of South America. Several varieties of these 
trees are utilized, and are extensively cultivated in various parts of India, 
especially in the Himalaya Mountains, and in Ceylon and Java. There 
are numerous preparations of cinchona used in medicine, all having the 
same action because of the presence of the active alkaloid, quinin. 

Quinin sulfate, in which form the drug is generally used, is a white crys¬ 
talline powder, having a very bitter taste. Its most important use is in the 
treatment of malaria, in which disease it has a direct curative effect. This 
is due to the fact that quinin, even in very dilute solutions, is poisonous 
to the germs which cause the disease by invading the patient’s blood-cells. 
It is best to precede the administration of quinin by a dose of calomel, and 
then, starting four hours before the expected chill, to give five grains of 
quinin every hour for four hours, so that a large amount has been taken 
before the chill would naturally occur. If the dose is large enough, there 
is no chill. This treatment is continued long enough to eradicate the germs 
from the blood, other drugs being required in the convalescent stages. In 
severe cases it is sometimes necessary to administer quinin by injections 
under the skin, or by rectum. To prevent infection in a malarial district, 
about six grains a day should be taken. Quinin is used also to reduce 
fever in other conditions, but it is not as satisfactory as some other measures. 
In combination with other drugs it is often given as a tonic. A large dose 
of quinin will cause ringing in the ears and some deafness. Certain people 
are very susceptible to its influence, and notice this disturbance after a small 
dose. People who live in malarial countries, and who are accustomed 
to take the drug, sometimes take enormous doses without any unpleasant 
effect. Very large doses are said to have caused temporary blindness or 
deafness, and various eruptions on the skin. 





Cinnamon 

Climate 


THE STANDARD FAMILY PHYSICIAN 


232 


CINNAMON. —The inner bark of several species of Cinnamomum , plants 
growing in China and in Ceylon. The bark contains tannic acid, and a vol¬ 
atile oil which gives it its peculiar aromatic odor and taste. Its principal 
use in medicine is to disguise the taste of less agreeable remedies. Cinna¬ 
mon has a stimulating effect on the stomach and intestine, and is some¬ 
times used in watery diarrheas, or in relieving distention. It is occasionally 
of service in controlling bleeding from the womb. The form in which the 
drug is usually given is as the water of cinnamon, the dose being a wineglass¬ 
ful or less, or as oil of cinnamon in drop doses. Large doses are poisonous, 
largely because of the presence of a high percentage of a phenol ( eugenol ) 
in the volatile oil. 

CIRCULATION. — See Introductory Chapters (pp. 64-65). 

CIRCUMCISION. —Term applied to the operation for partial removal 
of the foreskin of the penis. Among the Jews this forms part of a religious 
ceremony. Under ordinary circumstances the operation is done when the 
preputial opening is too small or has become contracted by inflammatory 
processes, thus constituting an obstruction to the ready exit of the normal 
or pathological secretions from the urethra. In small children the condi¬ 
tion is often congenital. Circumcision is not dangerous in children when 
conducted by a properly experienced person and with appropriate precau¬ 
tions. The wound demands careful attention as regards cleanliness. After 
urination the surrounding parts should be washed, and the wound itself 
dressed with a salve or lotion, and covered with aseptic gauze. The 
application should never contain carbolic acid. See also Foreskin, Dis¬ 
eases of. 

CIRRHOSIS. — See Liver, Diseases of. 

CITRIC ACID. —A white, crystalline, acid compound, obtained princi¬ 
pally from lemon-juice, but found also in smaller amounts in other acid 
fruits, as the orange and strawberry. The acid itself is seldom used in med¬ 
icine, as lemon-juice seems to act better. As a preventative and curative 
agent in scurvy, lemon-juice is very valuable. It is sometimes given in 
rheumatism and in catarrhal jaundice. It is also frequently used to flavor 
medicinal mixtures, and to mask the taste of disagreeable drugs. Some¬ 
times sick children can be persuaded to take water as freely as they ought 
to, if it is given in the form of lemonade. Lemon-juice has a slightly stimu¬ 
lating effect on the kidney. It is of service also in the treatment of an ir¬ 
ritable bladder, especially if such be due to an increased acidity of the urine, 
for lemon-juice makes the urine more alkaline. This is a fact contrary to 
the opinion of many superficial thinkers who advise against the use of acids 
because they increase the acidity of- the blood. The acid of lemon-juice is 
readily oxidized, and causes the blood to be more alkaline. 

CLAVICLE. —See Introductory Chapters (pp. 33-34). 

CLEFT PALATE. — See Harelip and Cleft Palate. 




233 


THE STANDARD FAMILY PHYSICIAN 


Cinnamon 

Climate 


CLIMATE AND DISEASE. —The relations between the effects of cli¬ 
mate and the treatment of disease are very complex for at least two reasons: 
in the first place because it is extremely difficult to define climate, and sec¬ 
ondly because the reaction to climate may vary within wide limits in different 
individuals. Thus, of two patients suffering from the same disease one may 
be benefited by a certain definite climate, and the other rendered worse. 

The most ideal type of climate for a great majority of sick people may 
be said to be one in which there is a maximum amount of sunlight, a mod¬ 
erate amount of moisture, and one in general in which the atmosphere is 
free from dust. Much, however, depends upon the disease under consid¬ 
eration. For a climate might have all the ideal conditions that the mind 
of the physician might desire, and yet by reason of difficulties of transpor¬ 
tation, and of obtaining food, proper housing, and protection, it might be 
badly adapted to the individual case. Thus in many cases of tuberculosis, 
in which the disease is not advanced too far, certain arid regions of New 
Mexico and Arizona have shown themselves to be very desirable as regards 
climate; but until such places shall have been placed within the region of 
civilization, and provided with good facilities for food supply, transporta¬ 
tion, and nursing, they offer little hope except for those who can command 
all of the resources in spite of the difficulties. 

A classification of climates is difficult to lay down. So many factors— 
such as pressure of the atmosphere, prevailing temperature, prevailing winds, 
average humidity, amount of electrification in the atmosphere, amount of 
sunlight, amount of rain, etc.—all contribute to the estimate of the general 
problem. There is no definite system for the classification of climates since 
no region on the globe has an unvarying series of climatic conditions; and 
at best one can only approximate the general average. So that when one 
has to take into consideration, not only the adaptability of the climate to the 
individual and the disease, but the economic features as well, it often be¬ 
comes a very perplexing problem. 

There are practically no individuals, either sick or well, that are not 
benefited in some degree at least by change of residence under different 
climatic conditions. This applies particularly to those afflicted with cer¬ 
tain disorders which are in part due to, or largely aggravated by, unhygienic 
climatic surroundings, such as tuberculosis, and the various neuroses and 
neurasthenias so largely incidental to city dwellers. The most important 
diseases that can be benefited by climate are tuberculosis, neuroses, mild 
mental disturbances, chronic Bright’s disease, chronic heait-disease, and 
chronic bronchial disease. In tuberculosis, as has already been outlined, 
no general rule can be laid down. Patients with incipient tuberculosis can 
recover even in a New York tenement region, if they can be made to live 
twenty-four hours a day in the open air; and, on the other hand, patients 
die of tuberculosis even in the most favorable climatic surroundings and 




Climate 

Coal-Gas 


THE STANDARD FAMILY PHYSICIAN 


234 


with all the aids and accompaniments that a munificent purse can afford. 
In general, however, it may be said, that patients with incipient tubercu¬ 
losis should avoid the cities, where fierce winds are common, where drafts 
are rendered more acute by the flue-like character of many of the buildings, 
and where dust is extremely prevalent, particularly dust that contains many 
septic micro-organisms. 

Tuberculous patients should avoid those climates where extreme changes 
are rapidly brought about, where the temperature falls 30 or 40 degrees 
in two or three hours and does it very often. They should seek a climate 
in which the sun shines much of the time, and where the humidity is not 
very marked; in certain cases, complicated by bronchial conditions, the 
presence or absence of humidity may, however, be of service in allaying 
irritation of the bronchial mucous membranes. Having found such a 
climate, where increase of weight and decrease of temperature and cough 
are secured, every attention should be given to further the cure of the mal¬ 
ady by the observance of hygienic and dietetic measures. Whether a patient 
should choose high altitudes or low, whether plains, forests, or lake regions, 
is a matter that should be determined for each and every individual by a 
physician who has paid particular attention to such climatic details. The 
following of general rules is often disastrous. 

Neurasthenics often derive much benefit from climatic influences. Here 
the great desideratum is to obtain a climate in which the maximum amount 
of sunlight can be secured, where daily interests are such as to lead to health¬ 
ful activity of the mind of the patient, and where freedom and absence from 
the haunts of men can be obtained. In the treatment of many neurasthenic 
conditions the assistance of a well-managed sanitarium is not to be disre¬ 
garded, for helpful and sympathetic suggestion on the part of a well-trained 
physician who has devoted his best energies to this type of work is of para¬ 
mount importance in the treatment of many neurasthenic states. These 
patients often do very well at the seashore. There the bathing, the inter¬ 
est in the ocean, and the general mildness of the atmosphere all contribute 
to bring about conditions of quiet and rest. Many also do well in moder¬ 
ately high altitudes, particularly after the acute stages of the illness have 
passed; but as a rule high altitudes are disadvantageous to pronounced 
neurasthenics. 

In the treatment of many kidney-diseases it is highly desirable that a 
warm, medium moist, and extremely equable climate be sought; a climate 
in which moderate skin-activity is stimulated, thus relieving the kidneys of 
a certain portion of the burden of excretion. Climates in which sudden, 
abrupt changes of temperature are prevalent are to be especially avoided 
by sufferers of kidney-trouble; but as in the case of tuberculosis, and also 
of neurasthenia, the rules laid down are to be interpreted in the most general 
manner. 



235 


THE STANDARD FAMILY PHYSICIAN 


Climate 

Coal-Gas 


For chronic heart conditions it has been generally taught that high alti¬ 
tudes are undesirable, although there is no doubt that a number of heart- 
affections do well in the relatively high altitudes of Colorado, New Mexico, 
and the like. As a general rule, however, such patients feel more com¬ 
fortable at lower altitudes, and in climates which are comparatively balmy, 
moderately moist, and with plenteous sunshine. A rolling, dry country, 
with moderate hill-climbing, and careful dietary are particularly advisable. 

As to the general problem of climate resorts or hotels, it is hardly within 
the province of a work of this kind to discuss. So many other factors, 
financial, social and otherwise, enter into the availability or non-availa¬ 
bility of the different places, that the patient who feels himself in need of a 
climatic change should consult his physician in order to bring about the 
desired result. 

CLOVES. —The unexpanded flowers of the Eugenia aromatica , a tree 
growing in the Molucca Islands, and cultivated in India, Ceylon, etc. 
Like other spices it is used largely for flavoring purposes, and for its 
stimulating and warming effect in colic, flatulence, and distention. It is 
sometimes given in consumption, and is said to control the cough and expec¬ 
toration to some extent. Toothache may often be relieved by placing a 
pledget of cotton soaked in oil of cloves in the cavity of a decayed tooth. 
It is a good local application for crab-lice, and is sometimes used in a lini¬ 
ment. The dose of oil of cloves is about five drops, usually given in a cap¬ 
sule. Its active principle is a phenol ( eugenol ), found also in cinnamon oil. 

CLUBFOOT. —A deformity in which the foot is directed inward and 
generally also downward (see Fig. 102). The deformity is often congenital, 
but may arise also by reason of the paralysis of certain muscles of the lower 
leg, and also in consequence of inflammations of the joints of the foot. If 
the affection is not treated the foot remains directed inward, and the patients 
are compelled to step on the extreme edge of the foot. Patients with marked 
deformity must walk on the back of the foot. This causes extremely disa¬ 
greeable callosities and ulcers on the foot, which heal with great difficulty. 
A very important question in the treatment of congenital clubfoot is the 
time to begin. Surgeons believe it best to operate as early as possible to 
accomplish a favorable result. By the time the child commences to walk 
the affection should be corrected to such an extent that the sole, and not 
the outer edge of the foot, touches the ground. Treatment includes mas¬ 
sage, bandages, and splints, especially with plaster jackets. If a clubfoot 
does not come under treatment until late, it requires the cutting of tendons, 
and extensive operation to put the foot into the correct position. 

COAL-GAS POISONING.— A characteristic type of poisoning caused by 
carbonic oxid, or carbon monoxid (CO), a poisonous, inflammable gas 
formed by incomplete combustion of carbon with oxygen. The develop¬ 
ment of this gas may be caused by heating with open coal-pans (as in build- 




236 


Cod-&v P e 0 r iS o^ ing THE STANDARD FAMILY PHYSICIAN 

ings under construction), or by too early closing of the damper, or by the 
stopping up of stovepipes. Carbonic oxid is contained also in illuminating- 
gas, especially in water-gas, which may escape into the living-rooms through 
leaks in the gas-pipes or through open gas-jets. It is found also in mines. 

Carbonic oxid acts on the hemoglobin of the blood in such a manner as 
to prevent the interchange of oxygen usually taking place in the blood. 
The important symptoms are headache, dizziness, tremors of the muscles, 
sounds in the ears, extreme weakness, and unconsciousness. The face is 
red to bluish. There may be convulsions and asphyxia (always in the severe 



cases), and death takes place with small, slow pulse from heart-paralysis 
and asphyxiation. Treatment consists in prompt removal of the patient 
into a pure atmosphere, and in artificial respiration. It is imperative 
that the latter be started early and be perseveringly and unremittingly 
continued, even for hours. During the artificial respiration, heat, oxygen, 
infusion of hot salt water (i per cent.) into the rectum, and hot coffee may 
be administered. 

COCAIN-POISONING. —A morbid condition produced either by an 
overdose of cocain, or by the continued use of the drug. The acute form 
of this disease is probably always caused by excessive medicinal doses of 
the remedy. The poisoned individual at first creates the impression of 
being under the influence of alcohol; this is followed by marked collapse, 
sometimes by convulsions. If the patients do not succumb within the first 
hour, they usually recover. 








237 


THE STANDARD FAMILY PHYSICIAN cld^evon ^ 8 


Much more important and frequent is the chronic form which occurs in 
those individuals who habitually indulge in the use of the drug. The vast 
majority of these victims acquire the habit through the use of the mere¬ 
tricious catarrh-cures so widely advertised, most of which contain this 
deadly poison. The affection manifests itself by bodily, but especially by 
mental, weakness. Loss of memory, disturbances of sight and hearing, 
fainting spells, loss of flesh and strength, and even severe mental disturb¬ 
ances are the most prominent symptoms. There is but one remedy for this 
form of poisoning—a living death, even more terrible in its effects than that 
due to morphin. This is the immediate and complete withdrawal of the 
drug. This, however, can be successfully accomplished only in an institu¬ 
tion, as the unfortunate patients require careful supervision, owing to the 
occurrence of still more severe mental disturbances (often suicidal attempts) 
during the withdrawal of the drug. The public should be extremely 
cautious with regard to “catarrh-cures” of unknown composition; for many 
of these remedies, which purport to cure bodily ills, have not only no cura¬ 
tive effect on the disease for which they are used, but' in many cases are the 
direct cause of acquiring a lifelong habituation to a deadly drug. 

COCCYGEAL PAIN. —A violent and stubborn pain at the lower extremity 
of the vertebral column, in the coccyx, and which is particularly aggravated 
by every movement of the bowels. If the trouble is caused by malignant 
ulcers, or by bone ulceration, the only remedy is surgical interference. In 
most cases, however, it is the result of a fall or of a blow upon the parts in 
question. If hot compresses and hip-baths do not accomplish desired re¬ 
sults, operation on the sacrum may be necessary. 

CODEIN. —An alkaloid which, like morphin, is obtained from opium. It 
is a dimethyl-morphin. Codein is generally used in the form of codein 
sulfate, in doses of a quarter of a grain to a grain or two. It is used to quiet 
cough and to produce sleep. Its effect is much more uncertain and less 
powerful than that of morphin, but it is not followed by the same distress¬ 
ing nausea, and is less apt to cause constipation. In diabetes it sometimes 
acts favorably when given in increased doses. 

COD-LIVER OIL.— A complex oil obtained from the fresh or partly 
decomposed liver of the codfish. The oil is light to dark-red in color, 
has a mild, fishy taste, and contains, in addition to various fats and their 
acids, small quantities of iodin. It also contains iodin compounds in com¬ 
bination with fats or proteids, or both. It is probable that the value of 
cod-liver oil is due to the fact that it represents a food which is readily 
assimilated, and which may contribute very materially to improve the state 
of nutrition in all wasting diseases of adults as well as of children, such as 
scrofula, tuberculosis, chlorosis and anemia, rickets, and diabetes mellitus. 
It should never be administered when the digestion is impaired. The most 
suitable time in the day to administer the oil is one to two hours aftei supper, 





Coffee 

Colds 


THE STANDARD FAMILY PHYSICIAN 


238 


or between the meals of the day. In summer it is at times wise to omit its 
use entirely, especially when fresh cream can be obtained; nor should it be 
given to children under six months of age, or to individuals with intestinal 
disease. To children it should be given at first in doses of a teaspoonful, 
gradually increased to four; and to adults in doses of a tablespoonful, 
likewise increased gradually to four times that amount. Many cod-liver 
oil emulsions are more palatable than the pure oil. Their chief disad¬ 
vantage is their comparatively high cost. 

COFFEE. —The seeds of the coffee-tree (Coflea Arabica), two of which 
are contained in each cherry-like berry of the tree. From its home in 
Abyssinia and Arabia coffee has been introduced into the temperate and 
frigid zones, and has there become indispensable. Chemical analysis of 
the coffee-beans has shown them to contain, in the dry but unroasted state: 
io per cent, of water, 12 per cent, of nitrogen, 0.93 per cent, of caffein, 9.5 
per cent, of tannin, 12 per cent, of fat, and 12 per cent, of sugar. Roasting 
does not modify the amount of caffein, nitrogen, or fat. The amount of 
sugar, however, is diminished to 1 per cent., and the amount of tannin 
increased. Aromatic oils are set free, contributing to the aroma of the 
coffee. Sugar assists in the formation of the caramel of the roasted bean. 
The roasting must be done uniformly, should not last too long, and the sub¬ 
sequent cooling must be a rapid and not a gradual one. Roasted coffee 
should be kept dry. When preparing the beverage, contact of the ground 
coffee with metal should be avoided, and only actually boiling water should 
be used in making the decoction which should not be allowed to boil a second 
time. 

The stimulating effect which coffee exerts on the nervous system is the 
reason for its widespread use and abuse. Coffee may be the enemy as well 
as the friend of man. As its abuse banishes sleep and causes restless nights, 
so it may also give rise to severe conditions of irritation of the nervous sys¬ 
tem, and through it affect the heart. Nor is it of secondary importance 
from the standpoint of digestion. For it is questionable whether even small 
quantities are beneficial to digestion; and it is certain that the latter is 
partly or entirely interrupted by the indulgence in large quantities of coffee. 
Patients suffering from gout, in whom the stomach is generally also affected, 
had better forego the use of coffee. If the sensation of indolence follow¬ 
ing a plentiful meal appears to be lessened by a cup of coffee, this is not due 
to accelerated digestion, but to the stimulation exerted upon the brain. 
Many coffee substitutes are expensive, and furnish neither stimulation nor 
nutrition. The best substitute for coffee for the poor is a plate of hot soup. 

COLCHICUM. —The root and seeds of Colchicum autumnale , or meadow- 
saffron, a bulbous plant native to Europe. The active principle is an alka¬ 
loid called colchicin. Locally colchicum is an active irritant; and if taken 
in an overdose it may cause symptoms of violent inflammation of the 




239 


THE STANDARD FAMILY PHYSICIAN 


Coffee 

Colds 


stomach and intestines, which may prove fatal. There is intense abdom¬ 
inal pain, salivation, nausea, vomiting, and diarrhea, often accompanied by 
much straining and the passage of blood-streaked mucus. There may be 
giddiness, delirium, and collapse, or the patient may remain entirely con¬ 
scious. In case of poisoning the stomach should be emptied if possible, and 
tannic acid given. The services of a physician are, of course, required. 
Colchicum is used principally in gout, and is very helpful in this condition. 
It is often combined with iodid of potash for use in chronic rheumatism. 
The wine of the seed is given in doses of half a teaspoonful. 

COLDS. —As a means of protection against too marked a reduction of 
the temperature of the body—which normally is 98.6° F.—man is covered 
with skin. The adipose, or fatty tissue, which is found beneath the skin 
also contributes in this function. Fat, being a poor conductor, retains the 
body-heat and prevents too marked a reaction to the temperature of the 
environment which, were it otherwise, might be injurious to the body. In 
temperate and frigid climates this layer of fat is not sufficient; and hence 
clothes are necessary. These are likewise poor conductors of heat, and rep¬ 
resent, as it were, an external layer of adipose tissue. The skin is supplied 
with numerous blood-vessels which are kept in a certain state of contrac¬ 
tion or of expansion by the nerves. If the skin is acted upon by variations 
in temperature, which are felt as cold or as heat, the nerves in the skin 
convey an impulse to the cord, from where impulses which cause either a 
narrowing or a dilatation are sent to the blood-vessels. 

The stimulus of cold narrows the blood-vessels, causing less blood to 
flow through the skin. In this manner less blood is exposed to refrigera¬ 
tion, and thus too marked a cooling of the body is prevented. But if the 
blood-vessels do not contract rapidly on the stimulus of cold—that is, if 
they have lost their capacity of reaction; as, for instance, in consequence of 
weakness—this self-protective mechanism of the body is impaired and a 
large quantity of blood is cooled. The greatly refrigerated blood acts upon 
the internal organs and disturbs their activity, so that the many substances 
which should be excreted by these organs are retained in the body. As a 
result discomfort and chilliness, the first signs of a cold, manifest them¬ 
selves. If there happens to be any organ which has been weakened by a 
previous disturbance, that organ will be the first to suffer from the conse¬ 
quences of the cold, and will become the seat of a fresh attack of congestion. 
This renewed weakening of the affected organ permits the colonization of 
bacteria, which multiply, and thus may give rise to the various disorders 
resulting from exposure to cold. 

In order to prevent a cold it is important to maintain a healthy, well- 
nourished skin, which is rich in blood and capable of leading to cold stimuli 
(see Hardening), and also to keep up a moderate layer of fat on the body. 
In the early treatment of a “cold” it is important to induce profuse action 




Colic 

Consciousness 


THE STANDARD FAMILY PHYSICIAN 


240 


of the blood-vessels of the skin, up to the point of sweat-formation; this may 
be done by means of packs, hot baths, hot beverages, elder-tea, etc. The 
patient should also take an enforced rest, preferably in bed, in order to 
permit the readjustment of the circulation in the various organs of the 
body. 

COLIC. —A painful state due to the spasmodic contraction of the mus¬ 
cles of any hollow organ of the body. It is particularly prevalent in the 
intestine, constituting a very annoying, sometimes even extremely painful 
manifestation of various disorders of the bowels. Here it is due to irrita¬ 
tions of the wall of the intestine, caused by the presence of undigested food, 
by fermentation, or by inflammation. The presence of the gases of decom¬ 
posing and fermenting food is one of the most potent factors in the pro¬ 
duction of intestinal colic, which is usually extremely severe if constipated 
masses prevent the egress of these gases. The characteristic of colic is its 
occurrence in acute attacks, the bowel being quiet during the intervals. The 
duration and intensity of these attacks may vary greatly according to the 
character of the original disease. 

Colic is a very ambiguous symptom. It may be the manifestation of a 
simple irritation of the intestine, due to dietary indiscretions; it may be due 
to a tumor narrowing the lumen of the bowel; or it may be caused by adhe¬ 
sions of the intestine. It may, therefore, be of very little or of very serious 
importance in the individual case. In acute disorders colic passes off in a 
few hours or days; but in chronic affections it may persist for months or 
years. A special form of intestinal colic is due to lead-poisoning. The 
incarceration of gall-stones and of renal stones in the bile-ducts or ureters 
is often accompanied by colicky pains. 

Hot compresses to the abdomen, or over the site of the pain, act benefi¬ 
cially in most forms of colic; relief is sometimes obtained also by hot hip¬ 
baths or full baths. Certain medicines are likewise capable of rapidly 
removing the irritative condition of the intestinal musculature, sometimes 
more rapidly than any other measure. Hot-water or soap enemas are par¬ 
ticularly valuable in relieving colicky pains in the intestine. Later, when 
the violent pains have been allayed, it is necessary to treat the causative 
disorders. 

COLLODION. —A solution of guncotton in alcohol and ether. It is a clear, 
colorless fluid of a sirupy consistency, and smelling strongly of ether. When 
painted over a part, the ether and alcohol evaporate, leaving a thin, trans¬ 
parent coating which serves as an air-tight dressing. Collodion is some¬ 
times rendered more flexible by the addition of five per cent, of Canada 
turpentine and three per cent, of castor-oil. The film left by the evapora¬ 
tion of this mixture does not contract as does pure collodion, and is more 
likely to stay in position. Cantharides is sometimes applied in collodion. 
The strength may be varied to produce merely a reddening of the skin or 




241 


THE STANDARD FAMILY PHYSICIAN 


Colic 

Consciousness 


an actual blister. Collodion is very inflammable, and great care should be 
taken to keep it where children will not be likely to play with it. 

COLOCYNTH. —The fruit of the Citrullus colocynthis, or bitter cucum¬ 
ber, deprived of its rind. The fruit is a round gourd about three inches in 
diameter. It is grown in many of the tropical countries. Colocynth is a 
purgative, producing a watery stool. It is used in conditions where it is 
desired to reduce the amount of water in the system, as in dropsy, or col¬ 
lections of fluid in the chest or abdomen. It is never used alone, but is 
always combined with other purgative drugs, being an ingredient in several 
well-known pills, such as the compound cathartic pill and the vegetable 
cathartic pill. 

COLOR-BLINDNESS. —Total or partial inability to perceive or to dis¬ 
tinguish colors, usually a congenital and incurable defect. Acquired color¬ 
blindness is a deep-seated affection of the eye, the recognition and treat¬ 
ment of which requires an exact medical examination. The congenital 
form of the affection usually manifests itself in inability to distinguish certain 
colors, red and green, for instance, being often confounded. In some cases 
the individual is altogether unable to recognize colors, everything appearing 
as gray on gray. The former defect is by far the more frequent one; the 
latter is very rare. 

The faculty of recognizing colors is of great practical importance, and 
railroad-companies especially insist upon their employees possessing this 
ability, as the mistaking of the colors of signals may lead to frightful acci¬ 
dents. Railroad- and steamboat-companies, therefore, demand that appli¬ 
cants for positions in their service be examined by oculists; color-blindness 
precludes their appointment. The ability to recognize colors is of great 
importance also in military service, especially in the navy. Many persons 
may never discover that they are color-blind; others become aware of it 
only when they make a serious mistake in the selection of colors. 

CONCEPTION. —See Reproduction. 

CONDYLOMA, BROAD. —See Venereal Disease. 

CONGESTIONS TO THE HEAD.— See Brain, Diseases of. 

CONIUM.—' The leaves and fruit of Conium maculatum, or poison- 
hemlock, a small herb, originally a native of Europe, but now grown in 
America. It contains an active principle known as coniin. Conium is very 
little used as a medicine at present, interest in it centering chiefly in its 
poisonous qualities. It is related that Socrates met his death thiough the 
administration of this drug. Conium acts mainly by depressing the termi¬ 
nations of the motor nerves at their junction with the muscular tissue, 
causing paralysis. 

CONJUNCTIVITIS.— See Eye, Diseases of. 

CONSCIOUSNESS, DISTURBANCES OF.— Consciousness is the term 
applied to the conception entertained by an individual, not only regarding 





Constipation 


THE STANDARD FAMILY PHYSICIAN 


242 


his own personality, but also concerning time and space. A person can 
fulfil the duties of his daily life in a proper manner only when his conscious¬ 
ness is unrestricted and his will has free play. Disturbances of this faculty 
may result from various diseased conditions, and may vary considerably as 
to degree of severity. 

Delirium is a state of confusion in which the patient’s conception of 
time and space is very obscure. He is uncertain of his whereabouts, be¬ 
comes erratic, does not recognize his usual surroundings, and is annoyed 
by various sensory disturbances. Not uncommonly he looks upon him¬ 
self as a stranger and refers to himself in the third person; or he believes 
himself a new individual because he has entirely forgotten everything that 
took place before his illness. When recovery takes place he may remain 
totally ignorant of the events which occurred during his sickness, so that as 
a matter of fact he leads a true double life. On the other hand, after having 
been visited by a number of attacks, the patient frequently is able to remem¬ 
ber what occurred during previous ones. These conditions, which lead to 
a sort of “divided personality,” have been largely made use of in fiction. 
They are often observed in that form of epilepsy in which the characteristic 
feature is a clouding of the intellect; and they are associated also with 
hysteria, somnambulism, and with the hypnotic state. Compare the article 
on Sleep. 

Where the loss of consciousness advances to such a degree that the patient 
is unaware of certain natural processes in the system, the condition may be 
referred to as stupor or stupefaction. Urine and feces are voided involun¬ 
tarily; the act of swallowing is disturbed; and the sensitiveness of the skin 
is diminished. As the result of lying constantly in one position, ulcers of 
various sizes may develop, especially at points of the skin where pressure 
occurs. The manner in which these may be avoided is described under 
Sick, Nursing of. This condition of stupor is developed in the course of 
diseases which are accompanied by protracted, high fever, such as typhoid, 
and it may occur also in cerebral and mental affections. For complete loss 
of consciousness, see Unconsciousness. 

CONSTIPATION. —A wide-spread disorder which occurs in both sexes, 
especially in women, and at all times of life. The disorder may exist with¬ 
out change for twenty or thirty years, owing to the carelessness of the patient. 
Some persons are troubled with constipation from infancy to old age. In 
babies it may occur as the result of congenital intestinal weakness; but it is 
more apt to be due to a milk-diet. Constipation occurs most frequently in 
persons of thirty to fifty years of age, and on an average three out of every 
ten persons are affected by it. The causes of this disorder are to be found 
chiefly in the habits of life, especially in faulty diet and unhygienic ways of 
living. Regarding nourishment it may be said that a limited diet, particu¬ 
larly an exclusive meat-diet, is very undesirable. As the result of the over- 





243 


THE STANDARD FAMILY PHYSICIAN 


Constipation 


rating of protcid foods in general, and of meat in particular, many individ¬ 
uals undervalue from their earliest years the beneficial effects derived from 
eating fruits and vegetables, giving these only secondary consideration. 
The musculature of the intestine thus loses the stimulation which a vege¬ 
table diet would give it. Proteid food leaves too little residue, giving the 
intestinal walls less work to perform; their contractions become weaker and 
less frequent, and the result is a condition of intestinal inertia which is a 
constant cause of constipation. Insufficient bodily exercise is likewise a 
frequent factor, a sedentary occupation generally favoring the condition. 
In girls and women constipation is often caused by lacing, and also by 
carelessness in regard to the necessary evacuation of the intestine, for rea¬ 
sons of prudery, convenience, etc. Permanent weakness of the intestinal 
tract may develop in consequence of another disease, particularly in many 
forms of stomach-trouble. Constipation may be superinduced also by the 
undue use of purges, so commonly resorted to without the advice of a phy¬ 
sician, and which merely tend to still more increase the disability, until 
finally the condition becomes almost incurable. Some cases of constipa¬ 
tion seemingly occur without any specific cause. 

The underlying cause of constipation consists in a relaxation of the 
musculature of the intestinal walls which have lost the ability to contract 
quickly and forcibly. Another form of constipation is due to a spas¬ 
modic and too forcible contraction of the intestine. This is the oppo¬ 
site of the first condition, and generally results from excessive irritation of 
the nerves of the intestinal musculature. It is believed by some that con¬ 
stipation may cause intestinal obstruction, but this view is not borne out by 
fact. A constipated condition lasting eight days or more would not affect 
the viability of the intestine. The intestinal content becomes dry and hard, 
and when finally passed it looks as if burnt; it is dark-brown in color, hard 
as stone, and is generally passed in separate knots or lumps, not unlike the 
excrements of sheep. These hard, round masses lie in the relaxed intes¬ 
tine, and must often be removed by artificial means. At times they form 
tumor-like swellings in the intestine, which may be felt through the abdom¬ 
inal walls. 

The treatment of constipation is difficult, especially if the case is of long 
standing; and it requires as much patience and energy on the part of the 
patient as from the physician. In order to be effective, the treatment often 
has to be continued for months and years. The first thing to do is to dis¬ 
continue the use of all purges, as these overstimulate the intestine, lea\ing 
it more sluggish afterwards. The patient must accustom himself to a fixed 
mode of living, and to take his meals at settled hours, and he should go to 
the toilet regularly, the best time being on arising in the morning, 01 imme¬ 
diately after breakfast. When the bowels show an inclination to mo\e 
they should never be restrained. A glass of cold water before breakfast, 



Consumption 

Convulsions 


THE STANDARD FAMILY PHYSICIAN 


244 


and before retiring, acts as a sufficient stimulus for some persons. Plenty 
of brisk exercise, such as walking, hill-climbing, gymnastics, athletics, 
bicycle riding, etc., is advisable (see Gymnastics). Careful daily massage 
is also beneficial, especially the vibratory massage (see Massage). Elec¬ 
trical treatment of the intestine is to be recommended, particularly as it may 
be combined with massage if proper electrodes are selected. 

More important than this mechanical treatment is the use of a properly 
selected vegetable diet. Meat and proteid foods should be taken in small 
quantities only; whereas fruit and vegetables, either raw or cooked, should 
be eaten three or four times a day; some early in the morning, and some 
before retiring. Grapes are especially to be recommended, and should be 
eaten at breakfast in quantities of from one-half to one pound. Of other 
important articles of diet for sufferers from constipation, may be mentioned: 
honey, buttermilk (one pint before breakfast), sour milk, kephir, coarse 
bread, gingerbread, figs, dates, tart foods and drinks, all kinds of spices, 
herring salad, pickles, spinach, lettuce, cabbage, cauliflower, etc. A de¬ 
tailed list should be given by the physician. Cocoa, chocolate, red wine, 
rice, sago, gruel, wheat bread, etc., are less valuable. The essential feature 
in the nourishment is that the patient eat often and much. Not to eat for 
fear of filling the intestine is an incorrect view. The diet must be coarse, 
firm, gritty, and voluminous in order to cause the intestinal muscles to con¬ 
tract, and to throw off the contents of the intestine. An excessive diet is to 
be recommended especially in the beginning of the treatment. After regu¬ 
lar movements have been established the diet may be regulated. In con¬ 
nection with the treatment here outlined, cold hip-baths (48° to 36° F.) of 
two minutes’ duration may be beneficial. Enemas of water, oil, glycerin, 
etc., should be used only in exceptional cases, and when prescribed by the 
physician. 

CONSUMPTION. —See Tuberculosis of the Lungs. 

CONTUSIONS. —Injuries brought about by blunt force, as by a blow, a 
knock, the falling of a heavy object upon some part of the body, squeezing, 
by being run over, or by a fall. The rupture of small blood-vessels nearly 
always taking place in such accidents, extravasations of blood under the 
skin (so-called “bruises”) are brought about; or injuries of larger veins 
lead to the formation of blood-tumors. The blood that escapes from the 
vessels enters the skin, and discolors it into a dark blue. Gradually, by 
transformation of the blood-pigment, this color changes into brown, green, 
and yellow. If the hemorrhage is very deep-seated, the color of the skin 
remains unchanged. Joints affected by a contusion become swollen and 
painful, and their movability is impaired. If sufficient force is used, mus¬ 
cles may be crushed, bones splintered, and sinews and arteries torn. Con¬ 
tusions affecting the skull, chest, or abdomen, may result in shock and 
injury of vital organs. An individual thus injured sinks to the ground in a 





245 


THE STANDARD FAMILY PHYSICIAN 


Consumption 

Convulsions 


faint; he becomes unconscious, grows pale, and vomits. In some cases 
death takes place at once; in others coughing and vomiting of blood occur, 
and blood is discharged with the urine. See also Brain, Concussion of. 

Slight contusions are treated with cold compresses (water or lead-water) 
which must be frequently renewed; bruised limbs are placed in an elevated 
position and firmly bandaged if necessary. Massage may be prescribed by 
the physician. The practise followed by many mothers, when a child in¬ 
jures its head by a fall, of immediately pressing the bruise with a spoon, is 
very appropriate. The pressure distributes the blood, and facilitates its 
absorption by the lymphatics, either preventing the discoloration from 
developing, or causing it to remain small. Hot or cold compresses sub¬ 
serve a similar end. Blood-tumors which suppurate should be opened, as 
otherwise blood-poisoning may result. For the treatment of wounds caused 
by contusions, see Wounds. 

CONVULSIONS. —Localized or generalized spasms of the body, which 
may or may not be accompanied by loss of consciousness. To the laity 
a convulsion is a serious affair, and as a rule their judgment is justified, for 
the occurrence of a severe convulsive seizure is always indicative of some 
profound, if not dangerous, affection of the brain. But there are many 
causes for convulsions, and some indicate more serious disorders than others. 
It is not practicable in a work of this kind to outline all the possible forms 
of convulsions, so only the most important varieties will be discussed in this 
place. 

Of the various causes for convulsive seizures, in the young especially, 
high temperatures {fever) due to infectious diseases is one of the most 
important. The presence of intestinal parasites is also to be reckoned 
with. The oncoming 0} injections diseases is often preceded by convulsive 
seizures. Other causes are tetanus , hydrophobia , poisoning from drugs , 
poisoning from alcohol , poisoning from kidney-disease , puerpeial eclampsia , 
apoplexy , brain tumor , general paresis of the insane, meningitis , epilepsy , 
and hysteria. A few words might be said about the characteristic forms of 
convulsion as present in these various conditions. 

In high fevers due to acute infectious diseases, such as measles, scarlet 
fever, typhoid fever, dysentery, etc., the effect of the temperature on the 
brain-tissue is such that generalized convulsions may occur. They occur 
practically only in children, and usually only when the tcmpeiature has been 
high for a considerable length of time. They are more prevalent in those 
children who show similar convulsions, or milder convulsive movements, at 
the beginning of an attack of infectious disease. The coriect treatment for 
these is to reduce the temperature by proper bathing or sponging, and to 

have the bowels emptied as rapidly as possible. 

Convulsions due to intestinal disturbances are by no means uncommon, 
and are often confused with true epilepsy because of their epileptiform 





Convulsions 

Copaiba 


THE STANDARD FAMILY PHYSICIAN 


24 G 


character. These also occur almost solely in young children. Overeating, 
rapid eating, the presence of tapeworms or even of pinworms may induce 
these convulsive movements, usually associated with other signs of indiges¬ 
tion or of worms. Naturally, treatment would take into consideration the 
removal of the exciting cause by enemas, cathartics, etc. 

A few specific infectious diseases are attended by very characteristic con¬ 
vulsive seizures. Typical of these are tetanus and hydrophobia. In these 
diseases there is a previous history of a wound or a dog bite, and later devel¬ 
opment of strong, tonic, muscular contractions. These tonic contractions 
differ from the ordinary clonic contractions of epilepsy and hysteria by the 
rigidity of the muscle, the arm or leg or hand being drawn up tightly in 
one position and not alternately drawn up and extended. The character¬ 
istic forms of convulsions in tetanus and hydrophobia are described under 
Rabies and Tetanus. 

Certain drugs have a peculiar action on nerve-tissue, causing irritation 
of the brain centers or spinal cord centers with the production of convul¬ 
sions. The most characteristic of these is strychnin, but drugs like calabar 
bean, cocain, belladonna, and even codein in children, may bring about 
convulsive movements. The convulsions of strychnin are very character¬ 
istic. They are tetanic in nature, that is of the tonic class, and are not 
accompanied with loss of consciousness. They involve the muscles of the 
jaw (causing lockjaw), the muscles of the back of the neck (drawing back 
the head), and the muscles of the spine (bowing the body backward). In 
severe cases the spasms are so marked that the body rests on the heels and 
head. The convulsive seizures of alcoholic poisoning are described in the 
article on Alcoholism. 

Kidney-disorders are apt to cause convulsive seizures because of the 
retention of poisonous products which should have been eliminated by those 
organs. The convulsions are epileptiform in their general character, as 
described in the paragraph on Bright's disease in the article on diseases of 
the Kidney. They do not differ in any essential particular from the con¬ 
vulsions known as eclamptic convulsions, which are frequently found as the 
result of insufficient kidney action in the period of child-bearing (see also 
Eclampsia). 

The peculiar convulsions of apoplexy ar described under Brain, 
Apoplexy of. From that article it will be seen that at least three different 
effects are to be separated: one resulting from hemorrhage into the brain 
substance; the second following stoppage of a blood-vessel of the brain 
without hemorrhage; and the third caused by stoppage of the blood-current 
due to gradual occlusion of a vessel. In each and every one of these con¬ 
ditions, the result is due to the circumstance that a certain portion of the 
brain has been deprived of its blood supply. This area then becomes de¬ 
generated, breaks down, and constitutes a weak part of the nervous system. 





247 


THE STANDARD FAMILY PHYSICIAN 


Convulsions 

Copaiba 


The convulsions of apoplexy therefore vary according to the cause. They 
are usually associated with some degree of paralysis. 

Brain tumors may produce generalized convulsions, but more frequently 
they cause localized convulsions of the type known as Jacksonian epilepsy. 
In this the arm or leg may become affected with a trembling or shaking, or 
may go through gross movements, the patient being fully conscious of what 
he is doing (see Epilepsy). 

In general paresis of the insane, the convulsions either resemble those 
of epilepsy or are typically apoplectic in character, being followed by a 
certain amount of paralysis of either side of the body. This paralysis is as 
a rule much more transient in general paresis than when due to apoplexy. 
Fuller descriptions of these attacks will be found in the article on Brain, 
Softening of. 

The production of general convulsions in meningitis is usually accom¬ 
panied with a very high temperature and very active delirium, occasion¬ 
ally with a stuporous state. These convulsions are not to be distinguished 
in general from those accompanying high fevers from other causes; but the 
presence of various jerkings of the muscles of the eye or face, and the local¬ 
ized disturbances of the large nerve-trunks at the base of the brain, may 
serve to separate meningitis from other febrile disorders. 

The convulsions of epilepsy and hysteria are very similar, and affect 
both sexes. In epilepsy there is, however, usually a preliminary warning 
(or aura)] the patient generally cries out; there is sudden loss of conscious¬ 
ness; and the patient falls and very frequently either bites his tongue or 
bruises himself in some manner or other. The hysteric rarely hurts himself, 
although this is not an absolutely distinguishing feature. Further consid¬ 
eration of these forms of convulsion will likewise be found in their respective 
chapters. 

The general treatment of any convulsive attack, pending a more accurate 
diagnosis of the cause, consists in loosening the clothing about the chest and 
neck to prevent strangulation, the use of wedges between the jaws if there is 
a tendency to injure the tongue in any manner, and giving the patient plenty 
of fresh air. The bowels should then be emptied rapidly by an enema. If 
the temperature is very high it should be brought down by means of cold 
applications. If the convulsions continue it may be necessary to give a 
little chloroform, but it is highly improbable that a layman would attempt 
to treat continuing convulsions without trained advice. 

COPAIBA. —An oleoresin obtained from the Copaiba Langsdorfii, a large 
tree growing in Brazil. It is a yellowish, oily fluid, with a bitter, disagiee- 
able taste. Copaiba has a stimulating effect on mucous membranes, par¬ 
ticularly of the urinary tract. It is used in chronic bladder trouble, or in 
low-grade inflammations which show a tendency to become chronic, like 
the late stages of gonorrhea. It is sometimes serviceable in chronic bron- 






THE STANDARD FAMILY PHYSICIAN 248 

chitis. The oil of copaiba is given in capsule or emulsion in eight or ten 
drop doses. 

COPPER.— In medicine this metal is used only as copper sulfate or 
blue vitriol. This appears as clear, rhomboid crystals of a beautiful green¬ 
ish-blue color. Copper is locally very irritating, its chief use being as an 
emetic. An overdose causes violent inflammation of the stomach and 
intestine, with severe vomiting and diarrhea, metallic taste in the mouth, 
salivation, colicky abdominal pain, and perhaps convulsions and death. 
Eggs, milk, or even soap should be given at once in large quantities, and if 
possible the yellow prussiate of potash should be administered, although it 
is better to use the former antidotes rather than to take time to procure the 
drug. The dose, used as an emetic, is five grains. Externally the crystal 
is used as a caustic. 

CORNEA, DISEASES OF. —See Eye, Diseases of. 

CORNS. —Thickenings of the horny layer of the skin, forming circular 
or oval callosities over a joint, usually over the little toe. The painful¬ 
ness of the corn distinguishes it from other callosities. It is not situated as 
a smooth, horny layer upon the underlying part; but a vitreous, thickened 
plug descends in root form, often containing remnants of former hemor¬ 
rhages as black granules. These solid plugs press upon nerve-branches, 
and are therefore extremely sensitive to pressure. Corns are often con¬ 
fused with thickenings of mucous follicles over the ball of the big toe (bun¬ 
ions), which are of an inflammatory nature and lead to abscesses; this 
happens rarely with corns unless an injury occurs when cutting them. 

Corns are best treated with the aid of a 50 per cent, solution of potash- 
lye, which should be plentifully applied to the corn before any attempt is 
made to loosen the plug. It is advisable to scrape off layer after layer with 
a sharp knife rather than to cut, and to carefully loosen the last, innermost, 
horny substance with the point of the knife. In case of bleeding, lunar 
caustic or alum may be used. Great care must be taken to avoid infections. 
If such occur, and the toe becomes red and swollen, a physician should be 
consulted at once. A saturated solution of salicylic acid in collodion is a 
useful corn caustic. Its action is slow but effective, and not painful. 

Corn-plasters of caoutchouc, cotton, or leather, are merely preventives, 
and possess no curative value. Quacks and corn doctors have been respon¬ 
sible for the loss of many human lives by blood-poisoning, caused by lack 
of cleanliness in performing operations. 

CORPULENCE. — See Obesity. 

CORSET-LOBE LIVER.—See Dress. 

CORYZA. —Cold in the head. This affection is of so frequent occur¬ 
rence that every one believes himself to be quite familiar with it, but it often 
leads to consequences which are difficult of recognition by the laity. Acute, 
chronic, and nervous coryzas are to be distinguished. 







249 


THE STANDARD FAMILY PHYSICIAN 


Copper 

Coryza 


Acute coryza begins usually at night with a pricking irritation in the 
back of the naso-pharynx. There is an inclination to sneeze, and a sensa¬ 
tion of fulness and heat in the nose. The secretion is sparse at first, and is 
often mixed with blood streaks. After six to eight hours it becomes looser 
and contains mucus; later it turns yellowish-green, viscid, and resembling 
pus. Very frequently the secretion is watery. The duration of an attack 
of acute coryza varies from several days to weeks. After persisting for 
some time it may lead to a profuse, yellowish, purulent, often malodorous, 
secretion; when this occurs the accessory cavities of the nose (the maxil¬ 
lary and frontal sinus) become involved. This suppuration within the ac¬ 
cessory cavities, which is usually accompanied by daily headache lasting 
for hours, may heal spontaneously, but occasionally it requires operative 
treatment. 

In the chronic form of coryza, which may last indefinitely, the outflowing 
pus leads to the formation of polypi (see Nose, Polypi in) and to obstruc¬ 
tion of the nose. If an acute coryza extends to the larynx and the bronchi, 
it will result in hoarseness and cough. This annoying complication is a 
regular occurrence in some persons, especially in winter. Coryza may 
spread also to the naso-lacrimal canal, leading to running of the eyes and 
to catarrh of the mucous membrane of the eyelids ( conjunctivitis ). Its 
transmission to the ear causes pressure and a sensation of dulness, ringing 
in the ears, and difficulty of hearing; it may even lead to inflammation of 
the middle ear. An acute coryza occurring in the course of an influenza—■ 
and such is the usual history—may be complicated by an extension from 
the middle ear to the mastoid cells, and from there the infection may spread 
to the meninges, causing a purulent meningitis. Mastoid complications 
are not infrequent and are often very serious. They frequently require 
operative treatment. 

Coryza of infants, if congenital and persistent, may be a serious sign of 
an infection of gonorrhea or of syphilis. In small children, owing to the 
narrowness of the naso-pharyngeal space and to the width of the opening of 
the Eustachian tube, catarrhal inflammation of the nose may extend to the 
middle ear, where it may give rise to a purulent inflammation, causing 
great earache, and perforation of the drum (see Ear, Diseases of). 
Coryza in small children and infants is always a very troublesome disease, 
as many do not attempt to breathe through the mouth. They suffer, there¬ 
fore, from shortness of breath, even from attacks of suffocation, and their 
ability to swallow is so impaired that it becomes difficult to feed them 

Countless remedies are recommended for the cure of coryza, but they 
do not deserve recognition. Smelling-salts and snuffmg-powders prepared 
with menthol and camphor may afford relief; but injections of cold water, 
alum solutions, etc., are absolutely dangerous. A steam-bath (breathing 
steam from a tall pitcher), if used on the first day of the affection, is some- 






Coug-h 

Cremation 


THE STANDARD FAMILY PHYSICIAN 


250 


times useful in suppressing a threatening coryza; but at a later stage of the 
disease it is ineffectual. The dry air of rooms, especially of steam-heated 
rooms, acts injuriously; whereas plenty of outdoor exercise in fresh, clear 
air is beneficial, even in the middle of a severe winter. If the disease is 
accompanied by severe headache, by profuse, persistent, and ill-smelling 
discharge, or by involvement of the ears, careful special treatment is required. 
The prevention of coryza, so far as it is an affection due to cold, may be 
accomplished by a general hardening of the body (see Hardening). 
Stockings should be changed frequently, and wet foot-wear promptly 
removed, especially in the case of children. 

Nervous coryza consists in an intense irritation accompanied by sneez¬ 
ing, and by a profuse watery (never viscid or purulent) secretion; it begins 
abruptly and ceases as suddenly. During the intervals between the attacks, 
the state of health is usually normal. The affection generally begins early 
in the morning, as soon as a part of the body is uncovered, and lasts for from 
several minutes to two hours. The eyes are often watery. In some indi¬ 
viduals the inclination to sneeze appears when they pass from one room into 
another with different temperature, or when they smell certain substances, 
as roses, or hay (see Hay-Fever). Some persons are affected when travel¬ 
ing on railroads (‘‘railroad coryza”); and others when in a crowd, or when 
looking into brilliant light. All persons suffering from nervous coryza, 
which is related to asthma, are themselves nervous; and in order to be 
cured permanently of coryza they must undergo a general treatment cal¬ 
culated to improve their nervous tone. This will cause a diminution of 
the excessive sensibility of their mucous membranes. Morbid changes in 
the nose are present in some cases; and the removal of these will cure the 
affection. 

COUGH. —A sudden, violent, spasmodic, and noisy expulsion of air 
through the closed glottis after a preceding deep inspiration. It is a reflex, 
having for its object the removal of some disturbing substance (mucus, 
etc.) from the respiratory passages. Hawking is a voluntary cough. Moist 
coughs are those in which fluid masses are expectorated. Dry, or irritative, 
coughs are accompanied by little or no expectoration. The irritation in a 
dry cough may originate either in the larynx or in other portions of the 
respiratory passages. It may be due to some abnormal process in the 
pharynx, or in the uvula, or even in organs which have no direct association 
with the respiratory passages; as, the liver, stomach, intestine, womb, 
teeth, or ear. In such cases it is a question of referred sensation. The 
irritation, in some instances originating in an affected organ (for instance, 
in the mucous membrane of the stomach), acts upon the pneumogastric 
nerve which, being in close relationship with the larynx and the bronchi, 
transmits the impulse to cough (see Plate XI.). If the larynx and the upper 
portions of the trachea are affected, the cough is usually accompanied with a 






















251 


THE STANDARD FAMILY PHYSICIAN 


Cough 

Cremation 


peculiar, shrill noise, or hoarse sound. In laryngeal croup this peculiarity 
is so pronounced that the initiated can recognize the disease from the char¬ 
acter of the cough alone. Cough is frequently preceded by a sensation of 
tickling in the larynx. 

Cough is merely a symptom of an abnormal process, and occurs, as 
stated, in a great many different affections. It is, therefore, not only out of 
place, but often actually harmful, to use any of the innumerable varieties 
of cough remedies on the market in the hope of curing an affection with them. 
A cough frequently masks a serious disease, and the employment of a cough 
remedy very often masks the symptom which it is essential to know if the 



Fig. 103. Fresh Pond Crematory. Fresh Pond, Long Island, N. Y. 


original malady is to be cured. This is particularly true in consumption. 
Many patients with this affection take cough remedies which conceal their 
true condition from themselves and friends until it is too late to be able to 
do anything for them. The indiscriminate use of cough remedies is respon¬ 
sible for the death of many individuals who might have been saved. 

CRAB-LOUSE. —See Lice. 

CREMATION.— The disposal of the dead by burning. This method 
has gradually become recognized of recent years, and a great number of 
crematories are now in use throughout the world. The objections raised 
by clergymen and jurists against cremation can not be considered valid, 
and it is merely just to leave it at the option of every one whether he prefers 
to have his body subjected to slow decomposition in the earth or to a rapid 

dissolution by heat. 

Very erroneous, even discouraging, ideas are disseminated among the 
public regarding the method of cremation. It is believed that the body is 








































Cremation 

Cupping-Glasses 


THE STANDARD FAMILY PHYSICIAN 


252 


surrounded by flames and that it burns with a blaze. Such is not the case. 
Fig. 103 shows the exterior of a crematory, the chapel; and Fig. 104 repre¬ 
sents its inside apparatus. The process of cremation is as follows. The 
coffin is placed on a platform (a) in the chapel of the crematory, and when 
the funeral service is over it gradually disappears from the view of the 
mourners through a noiselessly moving trap-door, while at the same time 
the opening in the floor is closed without noise. As soon as the coffin has 
reached the lower story, the wreaths are removed from it, and it is introduced 
into the crematory proper by means of a small, specially constructed iron 
carriage. About four to five hours previously the apparatus, especially its 
superstructure, has been heated sufficiently by means of gases developed in 
the generator to the left of the incineration chamber. As soon as it is 



Fig. 104. Cross-section of an incineration apparatus. 


intended that the incineration should commence, the development of gas is 
interrupted, and atmospheric air, which causes the combustion of the body, 
is freely admitted by the opening of slides through which only air that has 
been heated up to about 2100° F. enters the crematory. The superheated 
air surrounds the body and dissolves it, complete combustion taking place 
between the body-gases and the air. The colorless and odorless gaseous 
products of the combustion pass through separate channels, being gradually 
cooled off, until they escape through the chimney. The only residue of the 
combustion is a small quantity of whitish-gray, readily crumbling particles 
of bone, which fall through a grate into the space for ashes below the incin¬ 
eration chamber. After having been permitted to cool for about an hour, 
the ashes aie placed in an appropriate receptacle, which is soldered, sup¬ 
plied with the name of the dead, and preserved in an urn. The inciner¬ 
ation of the body of an adult, which generally is left in the casket, lasts on 
an average from an hour and a quarter to an hour and a half. Cremation 
is a much more hygienic method of disposal of the dead than burying. 







































































253 


THE STANDARD FAMILY PHYSICIAN 


Cremation 

Cupping-Glasses 


CREOLIN. —A dark-brown, sirupy fluid obtained form the distillation 
of coal-tar. It is used as an emulsion in water, forming a slippery, opaque 
mixture with quite a strong odor of carbolic acid. Creolin is strongly anti¬ 
septic and is commonly used as a vaginal douche in one or two per cent, 
solutions. It is sometimes used to wash out the bowel in dysentery, and is 
of service in certain eye and ear conditions. Creolin is poisonous, and 
should not be used without the advice of a physician. 

CREOSOTE. —A brownish, oily fluid, obtained for medicinal purposes 
by the destructive distillation of beechwood. Its chief constituents are 
guaiacol and creosol, and its action much resembles that of carbolic acid. 
It has a peculiar smoky odor and taste. An overdose causes symptoms like 
those of carbolic acid poisoning, and the treatment is the same. Creosote 
is used in consumption and chronic bronchitis, but it is very apt to upset 
the stomach. It is sometimes given to prevent fermentation in digestive 
disturbances. Applied on a little cotton to the cavity of an aching tooth, 
creosote will often give immediate relief. The dose is one to four drops, 

CRETINISM. —See Imbecility; Thyroid Gland, Diseases of. 

CROTON-OIL. —A pale yellow oil obtained from the Croton tiglium , a 
small tree of India. It is exceedingly irritating locally, and is one of the quick¬ 
est purgative agents used in medicine. It is given in a little olive-oil or but¬ 
ter, being placed on the back of the tongue. One or two drops will very soon 
produce a large, watery stool. It is, therefore, valuable when the patient is 
unconscious and it is desired to move the bowels quickly and thoroughly, 
as in apoplexy or uremia. Externally it is used to produce a blister, or in 
more dilute form as a counter-irritant for sprains, muscular rheumatism, 
etc. Overdoses cause inflammation of the stomach and intestines. 

CROUP. —See Diphtheria; Larynx, Diseases of. 

CUBEBS. —The unripe fruit of the Piper Cubeba , a plant found in 
Java. The berries are little, black, rough spheres, about the size of peas, 
having a peculiar taste. The oil or oleoresin of cubebs is used in late stages 
of gonorrhea, and in bronchitis. Sometimes dried berries are smoked with 
tobacco. The dose of the oil is five to twenty drops. An overdose acts as 
an irritant to the alimentary and urinary tracts. 

CUPPING-GLASSES.— Instruments used for purposes of counter-irrita¬ 
tion by drawing small quantities of blood to the skin. Cupping does not 
draw fluids from deeper organs. Its action is purely a local one and its 
benefits are due to purely nervous influences. There are two methods of 
cupping, dry and wet. Dry cupping-glasses are small vessels with thick¬ 
ened edges. In order to rarefy the air in them, they are w r armed over an 
alcohol flame and then rapidly pressed against the skin (see Fig. 105), to 
which they remain adhering, gradually drawflng blood to the surface and 
causing the skin to become red. By the application of a number of such 
cupping-glasses it is possible to increase the blood contents of a large aica 







Cyanide 

Death 


THE STANDARD FAMILY PHYSICIAN 


254 


of skin. The irritation becomes more effective if the dry cupping is com¬ 
bined with the wet method in that small incisions are made into the skin 
before the cupping-glass is applied. To produce a great number of small 
incisions closely together, a so-called spring-lancet is used. This consists 
of a square metal plate provided with numerous openings from which small 

knives spring out automatically upon pressing a but¬ 
ton. By placing this instrument on the skin and 
operating the spring, the knives will make numerous 
small incisions in the skin, causing blood to flow. A 
preliminary condition of wet cupping is the most scru¬ 
pulous disinfection of the instrument and of the skin. 
Wet cupping has little advantage over the dry method, 
save in the treatment of local effusions about joints. 

CYANIDE OF POTASSIUM POISONING.— A very 
acute form of poisoning which is of frequent occur¬ 
rence, owing to the widespread commercial employ¬ 
ment of the drug. Death usually takes place within 
a few minutes after the ingestion of a fatal dose; and 
very little can be accomplished by the administration 
of antidotes. The treatment consists in immediate 




production of vomiting, and the giving of cold douches 
F1 u pperfigure showfmeth - while the patient is in a warm bath. The victim usu- 
side Jt a ea cu5 s to he cauW n a ally utters a cry of anguish and falls prostrate, dying 

partial vacuum. Lower . . . r . . . 

figure shows cup applied within a lew minutes; or there may be nausea, vomit¬ 
ing, and difficulty in breathing, followed by convulsions, 
trismus (lockjaw), and finally a deep coma. In rare cases the patient may 
emerge from the state of coma within a few hours, and then go on to com¬ 
plete recovery. Artificial respiration is of service; also bleeding. The 
poisoning results from changes in the blood, whereby the hemoglobin is 
rendered unable to give up its oxygen. 

CYANOSIS. —Term applied to a bluish discoloration of the skin and of 
the visible mucous membranes. This symptom is observed in all diseases 
where circulatory or respiratory interferences are present; as, for instance, 
in cardiac and pulmonary affections. It is found also in cases of systemic 
poisoning, by which the conversion of venous blood (dark blood with 
diminished oxygen) into arterial blood (bright red blood, rich in oxygen) 
has been prevented. Treatment of this condition must be directed to the 
disease or factor which is the exciting cause. 

CYSTITIS. —See Bladder, Diseases of. 












TIIE STANDARD FAMILY PHYSICIAN 


Cyanide 

Death 



D 

DANDRUFF. —See Eruption; Hair, Care of. 

DEAD, DISPOSAL OF. —Owing to the more or less rapid disintegration 
of the body after death, the corpse becomes a menace to health. Hence 
the earliest possible removal of the corpse from the dwelling is necessary, 
especially when the extent of the residence is limited, or when the deceased 
has died of an infectious disease. A vault serves as a place to keep the dead 
body until its final disposal. 

The opinion prevailing among the public, that a cemetery can give rise 
to the propagation of infectious diseases, is erroneous, upon the whole, since 
the disease-germs entering the earth with the dead body soon perish there. 
At most, objections might be raised to the use of water from graveyard 
wells for drinking purposes. Cremation of the dead has lately become 
customary to some extent. Forceful reasons of a hygienic nature that rec¬ 
ommend cremation in preference to interment do not generally exist. Cre¬ 
mation is preferable in times of epidemics of infectious diseases. Extraneous 
reasons favor the destruction of the dead by fire, especially in large cities, as 
for want of suitable space the burial places must be moved further and 
further away from the cities, causing the transportation of the dead to be¬ 
come tedious and expensive. 

DEAF-DUMBNESS. —See Speech Disturbances. 

DEAFNESS. —Inability to perceive sounds; a condition which may 
affect one or both ears. Defective hearing of severe grade is often con¬ 
founded with deafness. The usual causes of deafness are serious and incur¬ 
able changes in the labyrinth. Cases of hysteria may be accompanied with 
deafness of one or both ears, but as a rule these cases are quickly cured. 
Unilateral deafness is difficult to demonstrate by examination. Congenital 
deafness, or deafness acquired in early childhood, leads to muteness (see 
Speech Disturbances). Vertigo frequently accompanies deafness. 

Deafness appearing suddenly, and accompanied by dizziness and vom¬ 
iting, is the result of a disease of the labyrinth (Meniere’s Disease) which is 
rarely cured. See Ear, Diseases of. 

DEATH.— The cessation of life is not always ushered in by gradual 
diminution of consciousness, but often occurs with unimpaired conscious¬ 
ness. At times death comes as a gentle slumber; at other times it is accom¬ 
panied by severe struggles. When death occurs, it is the duty of faithful 
nurses to act with presence of mind and with consideration. The last 
moments ought not to be made more difficult by painful expressions of 
grief on the part of the relatives. Quiet and consolation should surround 
the dying person. He should be kept clean and comfortable until he has 
drawn his last breath, and even after that. The lips should be moistened 







Death, Apparent 
Dengue Fever 


THE STANDARD FAMILY PHYSICIAN 


256 


with water or with fruit-juice, the perspiration wiped away, and every wish 
of the dying person carefully listened to and fulfilled if possible. 

After death, the corpse should be laid on its back and cleansed. It 
should be dressed without delay before rigidity sets in; otherwise dressing 
is difficult. The hair should be arranged, the eyelids closed softly, and the 
open mouth closed with a cloth drawn around the head and under the chin. 
The corpse should be covered with a shroud. In the summer time chlorid 
of lime should be sprinkled over the body, or the shroud which covers the 
body should be packed with salt and ice. The windows of the room in 
which the body lies may be opened, especially when the weather is cool. 
For the evidences of death, see Death, Apparent. 

DEATH, APPARENT. —The manifestations of life, especially those of 
the respiration and heart-beat, are sometimes reduced to such a degree that 
it appears as if life were extinct. The skin is cool to the touch and entirely 
devoid of color; no muscle is moved; respiration is suspended so far as the 
eyes are able to observe; and the pulse can not be felt. And yet, the differ¬ 
entiation between death and apparent death is of the utmost importance, 
because attempts at resuscitation must be made so long as death is not 
demonstrated beyond any question of a doubt, especially in persons who 
have met with accidents. 

The danger of being buried alive is scarcely ever present, as burial 
under ordinary circumstances takes place at a time when the signs of death 
are obvious. The latter are: bluish-red, dirty-red, or rose-red death- 
spots upon the dependent parts of the body, particularly upon the back; 
the eyelids remaining open when drawn apart; cloudiness and folds in the 
horny layer of the eyes; greenish discoloration of the skin in the soft parts 
of the body; cadaveric rigidity which generally occurs twelve hours after 
death, lasting from 24 to 48 hours; and lowering of the temperature of the 
body to below 8o° F., taken in the rectum. 

If these sure signs are absent, it is necessary to make more certain even 
if the respiration and pulse are no longer noticeable. Death has occurred 
if, upon constriction of a finger or a toe with a thread, the skin of the con¬ 
stricted part does not discolor to a distinct red, and later, blue; if, further, 
upon dripping hot water or sealing-wax upon the chest, the skin is not 
reddened, but if at once a blister is formed which bursts rapidly, showing a 
colorless background. In cases which even then remain doubtful, further 
guarantee is furnished by the electric current. This test, however, requires 
expert knowledge. In cases where suspicion exists that death is only 
apparent, a thorough examination should be made to discover the possible 
cause. It is occasionally noted that the position of limbs changes after death. 
This is due to the lapid onset of post-mortem rigidity, and it is by no means 
a sign that the patient has been alive. Changes of position of the corpse in the 
coffin are to be explained by the movements due to post-mortem rigidity. 







257 


THE STANDARD FAMILY PHYSICIAN 


Death, Apparent 
Dengue Fever 


DELIRIUM. —A condition of mental confusion, characterized by numer¬ 
ous and rapidly changing hallucinations. The patient views his surround¬ 
ings as through a veil; he is unable to locate himself, as it were; and as the 
hallucinations are often of a threatening nature and inspire him with fear, 
he is in a state of constant uncertainty and fright. He becomes very much 
excited, and uses force against his supposed enemies. Sometimes these 
patients are of a happy and joyous disposition; they have visions of flowers 
and gay colors, and hear ravishing music. A state of delirium may follow 
extreme bodily exhaustion, such as may be produced by severe hemorrhage, 
or by continued thirst or hunger (the vision of the “fata morgana” in the 
desert). It may occur also after intoxication by opium, hashish, or alcohol, 
and during severe attacks of fever. Certain forms of delirium, as for in¬ 
stance the visions of religious maniacs, are caused by psychic excitement; 
other forms occur during attacks of hysteria or epilepsy. Delirious states 
are transitory, but may remain for hours or days. It is scarcely necessary 
to add that such patients require constant watching. 

DELIRIUM TREMENS. —See Alcoholism. 

DELUSIONS. —See Insanity; Mental Diseases. 

DEMENTIA PR^ECOX. —See Insanity. 

DENGUE FEVER. —A tropical disease which runs an acute course and 
is very contagious. It is endemic in the Lesser Antilles, along the coast of 
the Red Sea, and on the west coast of Africa. From time to time the disease 
invades other countries. It has occurred in the.southern United States; 
and an epidemic of dengue raged in Philadelphia in 1798. The disease 
begins, after three to five days of incubation, with sudden fever, general 
indisposition, pains in the head, joints, and limbs, catarrhal symptoms, and 
a transitory rash which extends over the entire body in the form of a diffuse 
redness or red patches. A favorite site of the pain is in the knee-joints. 
This pain becomes worse on walking, and gives rise to a peculiar strutting 
gait which is characteristic of the disease, and which has given it the popular 
name of “dandy fever.” The fever, which may rise as high as 106° to 107° F., 
usually disappears in about three days together with the other symptoms, 
this stage being marked by a profuse perspiration. A day or two later, 
however, a second eruption may take place, which is uncertain in character, 
and may resemble measles, scarlatina, urticaria, or other 1 ashes. This 
second eruption may last anywhere from a few hours to several days; 
recovery follows its disappearance, although a complete return to health 

may be greatly retarded. 

The course of the disease is as a rule favorable. Fatal cases are rare 
and occur mostly in children or in persons afflicted with some other severe 
illness. Such persons should, therefore, be especially protected against 
infection during the prevalence of an epidemic; and in order to avoid 
actual contact with the subjects of the disease they had best be removed 




D?a n be!e7Memtu9 THE STANDARD FAMILY PHYSICIAN 


258 


from their homes for a time. The disease is extremely contagious, some¬ 
times spreading even more rapidly than influenza. Epidemics have been 
rare within recent years. 

DENTISTRY.— See Teeth, Care or. 

DIABETES INSIPIDUS. —A condition in which very large quantities of 
extremely thin urine are discharged. In cases of medium severity the quan¬ 
tity may vary from six to seven quarts in a day, but in severe cases it may 
increase to twice these amounts or more. In contrast to diabetes mellitus 
and to chronic inflammation of the kidneys, in which the quantity of the 
urine is generally also increased, the urine discharged in this disease does 
not contain any morbid constituents. In keeping with the great excretion, 
there is great thirst. As the supply of water rarely keeps up with the excre¬ 
tion, the tissues of the body become impoverished in water. This is made 
manifest by dry skin and by the absence of all perspiration. Whereas mild 
or medium degrees of the disorder are frequently borne for decades without 
any marked disturbances, a certain loss of strength always becomes mani¬ 
fest when the disease increases in severity. 

Diabetes insipidus, which is a very rare affection, generally appears very 
suddenly. Sometimes it accompanies the afflicted individual for life; at 
other times it disappears after a shorter or longer period. The real causes 
of the disease are not known. It develops most frequently in connection 
with other affections, such as influenza, pneumonia, typhoid fever, scarla¬ 
tina, etc. In some instances the disease is thought to be due to an affection 
of certain areas of the brain, but in the majority of patients there is no 
cerebral disorder. Treatment consists in careful nutrition, intended to 
counteract the threatening loss of strength, with simultaneous careful atten¬ 
tion to all other measures calculated to improve the condition of the body. 
Favorable results have been obtained in some instances by a very gradual 
restriction of the overabundant supply of water. This, however, is a double- 
edged measure upon which one should never decide without the most care¬ 
ful medical surveillance. Not much is to be expected of medicines. The 
disease is by no means incurable, even if many cases are so malignant from 
the very beginning that they are refractory to all treatment. 

DIABETES MELLITUS. —True diabetes; a disease characterized by the 
excretion of grape-sugar with the urine. Persons in whom the metabolic 
processes fail to make use of all the sugar and sugar-forming food which 
they eat, and who excrete part of this sugar with their urine, are designated 
as diabetic. There are two types of diabetes, a mild and a severe form. 
In the mild form, sugar is excreted only when sugar or articles closely allied 
to sugar (particularly starch and flour) are consumed. In the severe form, 
sugar is excreted independent of the above-mentioned articles of food, and 
seems to be developed from the proteids of the body. In cases of chronic 
diabetic disease, there are other chemical changes in the urine; and such 





259 _ T HE STANDARD FAMILY PHYSICIAN 8j3KS?Mitu. 

may occur also from inadequate treatment. The sugar contained in the 
urine is grape-sugar, so called because it was first found in fruits, particu¬ 
larly in grapes. Its fermentation causes the formation of the well-known 
spirits of wine. This sugar is a normal constituent of the tissue-juices and 
blood of animals. The remote causes of diabetes are as yet unknown, but 
it has been discovered that the disease stands in close relation to changes in 
the pancreas and to various diseases of the nervous system. From a prac¬ 
tical standpoint, the question of inheritance is of great importance. 

According to statistics, diabetes occurs at present more frequently than 
formerly, a fact which may with some justice be accounted for by the 
increased demand made upon the nervous system by the modern way of 
living. The largest number of cases occur after the age of 45 years and, 
contrary to most other diseases, the course is then slower and milder than 
when the disease appears in youth. The disease usually begins insidiously, 
and almost without exception in a mild form; if neglected, although some¬ 
times also in spite of careful treatment, this develops into the severe and 
dangerous type. 

The disorder has many symptoms, which may vary with each case. 
The most important of these are: Increased thirst, increased quantity of 
urine, loss in weight, unusual fatigue after exertion, mild and wandering 
pains in the muscles of the back and in the limbs, nerve pains (particularly 
in the hips and legs), spasms in the calves at night, diminished sexual desire 
in man, itching sensation and moist eruptions on the sexual parts of the 
woman, loosening of the teeth, receding of the gums around the incisors, 
weakening of the power of sight, and abscesses of the skin (so-called fu¬ 
runcles). These and similar symptoms are not necessarily all present, but 
they frequently alternate, one coming and another going. If only one 
symptom is considered, it frequently happens that the disease is not recog¬ 
nized and therefore incorrectly treated. It is therefore necessary, if one of 
the mentioned symptoms is present, or if there be any other health dis¬ 
turbance of doubtful origin, to have the urine examined for sugar. The 
best time for such an examination is three hours after a plentiful meal of 
bread, milk, and sugar. The night urine must not be taken for this purpose, 
for frequently it contains no sugar, even if much sugar is excreted during 
the day. Sugar is often found in the urine of patients who complain of 
nerve pains which were supposed to have resulted from a simple cold. 
Early recognition of the disorder is therefore important, firstly in order to 
cure the disease if possible, or at least to prevent an aggravation of the con¬ 
dition by proper regulation of the mode of living; and secondly because 
neglect means the development of the severe type of the affection, or the 
accompaniment of dangerous complications, such as falling out of the teeth, 
cataract, gangrene of the feet, inflammation of the cellulai tissues, arterio¬ 
sclerosis, and heart weakness. The patient generally succumbs to these 






Diabetes Meiiitus THE STANDARD FAMILY PHYSICIAN 


260 


complications, or to the increasing weakness, or to a peculiar brain paraly¬ 
sis; in some cases after one or two years, but more often after the disease 
has lasted a decade or longer. 

As has been remarked, there are malignant types of diabetes which defy 
all treatment. In the majority of cases, however, the course of the disease 
is materially influenced by proper treatment, which generally succeeds in 
averting the dangers, either permanently or for a long time. Too credulous 
diabetics are overrun with advertisements of remedies supposed to have 
fabulous success. These, however, are worthless, and only serve to fill the 
purse of the unscrupulous manufacturer. Owing to the conspicuous adver¬ 
tising, some of these remedies have even deceived physicians. In view of 
this fact it must be emphasized that there is no sure remedy for diabetes, 
even if medicine can and must be given for single disturbances. 

Treatment is above all else dietary. A proper division of rest and work, 
fresh air, muscular exercise, baths and other applications of water, light, 
heat, and cold, which act beneficially upon the general condition, are also 
of importance; but the welfare of the patient depends essentially upon the 
character of the nourishment. The fundamental principle in this respect 
is to limit the amount of sugar-producing articles allowed the patient, until 
no more sugar is excreted. If this is not feasible on account of its effect 
upon the general well-being of the patient, and upon the digestive organs, 
the limitation of the sugar-producing articles should at least be carried to a 
certain degree. Just to what extent this may be done can be determined 
only after careful examination, which demonstrates that each diabetic needs 
a special allowance of sugar-producing foods, suitable for his individual 
case. If this specialization is not carried out, but a general scheme of treat¬ 
ment adhered to, the result is more harmful than beneficial. Of late, since 
this fact has been recognized, it has become customary to send diabetics to 
special institutions, or to well regulated hospitals, where exact observation 
may be made of the sugar excretion and of the influence exerted thereon by 
the nourishment, and where the patients may learn to live in accordance 
with the requirements of their condition. For patients whose circum¬ 
stances permit it, summer cures at certain health resorts are advisable. In 
Europe the well-known watering-place of Carlsbad holds first rank, although 
of late Homburg and Neuenahr are also much frequented by diabetics. In 
the United States Mt. Clemens, Virginia Hot Springs, and Alma Springs 
are well thought of. The institutions, however, can not be replaced by such 
spas and therapeutic cures; and if only one procedure is possible, a stay 
in a suitable sanitarium or hospital should be given the preference. 

With regard to the diet, patients should be provided with a list on which 
the articles of nourishment are divided into groups. The first division 
embraces foods which, accorded in judicious quantities, are the foundation 
of the diet. This group contains all kinds of meat, eggs, and cheese, most 





THE STANDARD FAMILY PHYSICIAN Diabetes Memtus 


2G1 


vegetables, and all fat substances; the last-named are most valuable, 
especially butter. A second division includes foods which are to be totally 
excluded, such as all sugars and foods containing sugar (as honey, sirup, 
chocolate, sweetened fruits, fruit ices, etc.). If sweetening of the drinks or 
food can not be dispensed with, certain substances may be used which have 
the virtue of tasting sweet even in small quantity, and which do not harm 
the body. Of these there are several kinds, the most useful being saccharin 
and crystallose. These are bought in the form of minute pills or tablets, 
one of which possesses the sweetening effect of an ordinary lump of sugar. 
A third group includes foods which, although containing sugar-forming 
material, can not be entirely dispensed with. Such are: bread, potatoes, 
leguminous plants, rice, barley, oats, milk, and fruit. After a careful 
physical and chemical examination, the family physician should give the 
necessary directions to each patient as to the quantity to be eaten. The 
most difficult part of the diet to regulate is the quantity of bread and fruit, 
as both are very important for the well-being of the body, and particularly for 
the organs of digestion. Special breads are made for diabetics. These 
contain less flour and more albumen than the ordinary kind. The best 
known are the aleuronat breads, the gluten breads, and various kinds of 
pastry made by special processes of manufacture. With these products it is 
easier to satisfy the patient’s craving for bread, without harm from excess, 
than with the ordinary wheat and rye breads. These special kinds of 
bread are more expensive than ordinary breads; in fact, the entire diet 
required for a diabetic is more expensive than an ordinary diet. 

Of late, fruit has been recognized as a useful addition to the diet of a 
diabetic. Certain fruits contain very little sugar; for instance, sour apples, 
sour cherries, early oranges, cranberries, and huckleberries. On the other 
hand, many fruits, as usually prepared, are so rich in sugar that they should 
be given only in the smallest quantities and only in mild cases. As in the 
case of bread, attempts have been made to diminish the quantity of sugar in 
preparing fruits for the use of diabetics. Similar attempts have been suc¬ 
cessfully made with drinks, particularly with sparkling wines. These may 
be found free from sugar in almost all large distilleries. Regarding alco¬ 
holic drinks the patient may not choose for himself, but must obtain advice, 
the same as for the necessary articles of nourishment. This applies espe¬ 
cially to beers. Small quantities of light, thin beer are generally permissible; 
the actual quantity will differ in each case. As a rule the light, mild, domes¬ 
tic beers deserve the preference, as they are much poorer in sugar than the 
renowned Pilsener beer or the darker, sweeter beers. 

Thus it will be seen that there are many details to be observed in the diet 
of a diabetic in order to accomplish the desired result:—to keep up the 
nutrition of the body while excluding an excess of carbohydrates, which 
class of foodstuffs are not oxidized by the body as they should be. 




Diaphoretics 

Diphtheria 


THE STANDARD FAMILY PHYSICIAN 


262 


DIAPHORETICS. —See Domestic Remedies. 

DIARRHEA. — See Intestines, Diseases of. 

DIASTASE. —A ferment, or enzym, found in many of the lower plants, 
molds, etc., but obtained commercially for the most part from various 
grains, notably barley. This ferment, or enzym, has the property of digest¬ 
ing carbohydrates, notably starch; and in its commercial forms, as malt 
extract, it serves a useful purpose in the treatment of starchy indigestion. 

DIET FOR THE SICK. —The nourishment of sick patients is often one 
of the most difficult of subjects. The seriously sick should be given only 
such nourishment as is permitted by the family physician. It should be 
left to him, or to the nurse under his directions, to select the food. If his 
directions are carefully carried out the patient will not be overfed, nor will 
he be deprived of what is necessary, or given things that are harmful. The 
manner of serving the prescribed food to the patient is also very important. 
Above all, it must be appetizing. It is essential, therefore, to pay attention 
to the thorough cleanliness of the dishes, glasses, plates, etc., and to the 
proper temperature of the food and beverages. If they are to be warm, 
the proper temperature is 104° F. The food should not be placed in masses 
upon one plate, as daintiness of service is of much importance in stimulating 
a jaded appetite. 

Bedridden patients require an eating-board, and should be propped up 
with pillows while eating, so that they may enjoy their food in a raised posi¬ 
tion. Very weak patients should be hand fed. It is inadvisable to give them 
more than one teaspoonful at a time; and this should be given with the 
right hand, while the left arm reaches under the pillow and raises the pa¬ 
tient’s head. This feeding should be done at intervals of not more than two 
to three hours; also at night whenever the patient complains of dryness in 
the mouth, and is troubled by sleeplessness. If cracked ice is ordered, the 
fragments should be small, and should be administered in a teaspoon. 
Toothless old persons, small children, and patients who are not able to chew, 
should be given food macerated in milk, or finely minced. To prevent the 
spilling of fluids by the patients, special feeding cups provided with a beak 
are very useful. Glass tubes are also serviceable. If a patient is uncon¬ 
scious, his head should be turned to one side, the corner of the mouth 
opened with a finger, and the food given in a teaspoon. Frequent cleansing 
of the mouth is important, especially in those that are seriously sick. This 
can be done with a cotton swab wrapped about the little finger. 

DIGESTION. — See Introductory Chapters (pp. 53-58). 

DIGITALIS. —The dried leaves of foxglove (Digitalis purpurea ), a 
widely cultivated European plant. It is extensively grown in the United 
States, but more for ornament than for commercial purposes. The active 
principles in the leaves are glycosides, four of which are described at the 
present time. The details of their composition, however, can be best con- 




263 


THE STANDARD FAMILY PHYSICIAN 


Diaphoretics 

Diphtheria 


suited in technical works. The action of digitalis is very complex. It is 
extremely bitter and irritating to the stomach, and some persons with deli¬ 
cate stomachs are unable to take it. It is absorbed very slowly from the 
stomach, and has a very pronounced action on the heart and its nervous 
mechanism. The principal effect of digitalis is to strengthen the con¬ 
tractions of the heart-muscle as well as to increase the contractions of the 
muscles of the blood-vessels. This would tend to make the heart beat 
stronger and somewhat faster; but soon after the absorption of the drug the 
heart-regulating center in the medulla is implicated, and as a result of the 
irritation in this center the heart beats slower. 

Under the full physiological action of digitalis the heart beats slowly 
(say 50 per minute) but stronger; and the output of blood is increased, and 
the blood-tension raised throughout the body. This action, whereby all 
the organs of the body are better supplied with blood, may be continued for 
a long time under careful medical supervision, and digitalis is therefore one 
of the most reliable of all the heart-tonics. When given in large doses, or 
if accumulation of its effects takes place, the heart commences to beat more 
rapidly and irregularly, the blood-tension falls, and the patient appears to 
be seriously poisoned, with signs of cardiac distress and irregularity. This 
result often happens when the medication is prolonged, and it is usual to 
intermit when giving digitalis. The chief indications for its use are the 
various heart-disorders in which disturbance of compensation shows itself. 
The heart that is acting normally and is able to keep up compensation 
should not receive digitalis. Digitalis, moreover, is of practically little 
service where a quickly diffusable heart-tonic is required. It is often given 
also in kidney-diseases, but in these cases it is combined with other remedies 
in order to overcome its blood-raising effects. It is usually prepared either 
as an infusion given in half teaspoonful doses, or as a tincture in doses of 
five drops. 

DIPHTHERIA. —One of the most dreaded of the diseases which affect 
children. It is due to the diphtheria bacillus discovered by Loffier, which 
attaches itself principally to the mucous membrane of the throat and nose, 
where it grows in enormous numbers. Its extremely toxic products are 
a source of danger to either child or adult. The most frequent site of the 
disease is the pharynx. It develops in from two to seven days after infection 
has taken place, and is ushered in by chills, fever, vomiting, malaise, loss of 
appetite, and headache, followed by hoarseness (croup), difficulty in swal¬ 
lowing, and pains in the throat. Grayish-white patches, tightly adherent to 
the underlying tissues, are found on the red and swollen tonsils, palatal 
arches, and uvula. These gradually extend to the surrounding areas, and 
may spread down into the larynx and bronchi. This condition is accom¬ 
panied by a painful swelling of the neighboring lymphatic glands in the neck. 
These appearances are developed in 2 to 3 days, and in the milder cases lecede 





Diphtheria 

Disinfection 


THE STANDARD FAMILY PHYSICIAN 


264 


within 3 to 5 days. In the more virulent types of the disease, the symptoms 
are all increased in severity and are accompanied by high fever and general 
exhaustion. The poison developed in the body by the bacteria may also 
bring about severe damage to the heart, the pericardium, the lungs, the 
kidneys, and the nervous system; and the disease may result fatally from 
interference with respiration, from pneumonia, cardiac weakness, or from 

paralysis. Even if this unfavorable 
course is avoided, the recovery of the 
patient may be complicated by various 
sequelae which involve the heart, the 
lungs, or the kidneys. Or there may be 
paralyses of various kinds, affecting the 
muscles of the eyes, palate, larynx, chest, 
bladder, or rectum, including perhaps 
the entire arm or leg; or there may be 
long-continued hoarseness, loss of voice, 
disturbances of speech, squinting, etc. 

The course of an attack of diphtheria 
varies with the age of the patient, the 
general condition of the system, and the 
severity of the epidemic. The mortality 
is greatest from infancy up to the fifth 
or sixth year, and then declines steadily 
until it is practically nothing in adult 
life. During the prevalence of an epi¬ 
demic of diphtheria, parents must keep 
close watch over their children. Fre¬ 
quent examination of the throat may 
lead to an early recognition of the dis¬ 
ease in many cases before any other 
symptoms have appeared. Fig. 106 
illustrates the most suitable manner of 
holding a child for the purpose of exam¬ 
ining its throat. Any slight redness or swelling in the throat should serve 
as a warning, even before any membrane has appeared; and a physician 
should be called at once, in order that appropriate treatment may be insti¬ 
tuted and further dissemination of the disease prevented. 

If the diagnosis has been confirmed by the doctor, the patient must be 
isolated immediately, and the remaining children in the family kept under 
close supervision. It is advisable to send children with diphtheria to a 
special hospital if suitable quarantine can not be maintained at home. All 
articles used by the patient, or with which he comes in contact, should be 
either boiled for half an hour or soaked in some germicidal solution. The 



Fig. io 6. Method of holding patient in order 
to look into the throat. 







265 


THE STANDARD FAMILY PHYSICIAN 


Diphtheria 

Disinfection 


nurse should be dressed in gowns of washable material. Before leaving the 
sick-room, and also before every meal (none of which should be taken in 
the room where the patient lies), the hands must be thoroughly washed and 
disinfected, and the mouth washed out with some antiseptic gargle. At the 
termination of the disease, the rooms occupied by the sick person must be 
fumigated and then thoroughly aired. Convalescents also serve as a means 
for disseminating the disease, even for some time after their recovery, and 
this fact should always be borne in mind. 

The method of treatment generally adopted at the present day, and 
which has been thoroughly tested by observations without number, is by 
the injection of the curative antitoxic serum discovered by Behring. This 
is entirely harmless in its action and has triumphantly established itself 
in the confidence of the medical world in the face of great opposition. 
The earlier the patient can be given the benefit of this treatment, the more 
certain are its effects, and every moment of hesitation is unfavorable to the 
life of the patient. The brilliant results which have attended the procedure 
are shown by the statistics of the mortality, which has steadily declined from 
an average of 45 to 50 per cent, to 16 per cent. The curative effect of the 
serum is shown by the improvement in the general condition and strength 
of the patient, in the lowering of the temperature, the return of the appetite, 
and by the fact that the false membranes do not extend any further, but are 
thrown off. This favorable effect only follows the early administration of 
the antitoxin, before the poison from the bacilli has had an opportunity to 
do much harm to the system. 

In addition to the constitutional treatment, cold applications may be 
made to the throat, ice may be swallowed in small pieces, and if much irrita¬ 
tion is present relief may be obtained by gargling with cold, astringent 
solutions. Constriction of the pharynx or of the larynx, resulting from the 
swelling or from the exudations, sometimes leads to difficulty in breathing, 
or to choking, so that life is threatened; in such cases the timely introduc¬ 
tion of an intubation-tube into the larynx, or the operation of tracheotomy, 
may do much to revive the patient. The necessity for treating any subse¬ 
quent paralysis of the various muscles must be determined by the physician, 
and should be left entirely to his discretion. 

DIPSOMANIA.—See Alcoholism 

DISINFECTION.—Since it is known that a large number of diseases are 
due to the entrance of toxic bacteria into the body, and that these are 
present on every object with which one comes in contact, effoits should be 
made to reduce the possibilities of contagion by limiting or destroying the 
offending germs. This may be accomplished by methods of disinfection, 
and for this purpose heat in the form of fire, boiling water, or steam, and 
chemical substances which in weak solutions kill the bacteria, but which in 
stronger solutions are harmful to the tissues, are employed. Fire and boil- 





Domestic Remedies THE STANDARD FAMILY PHYSICIAN 


266 


mg water destroy bacteria very rapidly, usually within a few minutes. Live 
steam acts somewhat slower, although it kills even the most resistant forms 
in about half an hour. As a rule articles to be disinfected are exposed to 
live steam for at least an hour. 

Whatever comes in contact with a patient suffering from an infectious 
disease should be burned if of no value, and this applies especially to dress¬ 
ings soiled by purulent discharges. The linen for the bed and for personal 
use, as well as all metal objects, may be disinfected by boiling water. Live 
steam may be used for cleansing the wearing apparel. The commonly 
employed chemical disinfectants, which in dilute solutions may also be 
used in dressing wounds, are watery solutions of boric acid (5 to 10 per cent.), 
carbolic acid (1 to 5 per cent.), creolin (5 per cent.), lysol (5 to 10 per cent.), 
formaldehyde (1 per cent ), salicylic acid (1 to 3 per cent.), corrosive subli¬ 
mate (| to 1 per cent.), and also soap and chlorid of lime. Objects exposed 
to the action of these solutions require varying periods of time for their dis¬ 
infection, depending on the strength. 

The choice of method must be governed by the character of the articles 
about to be sterilized. Linen which is to be boiled later, may be soaked 
for twelve hours before removal from the sick-room in a 5 per cent, solution 
of cresol soap, or wrapped in cloths saturated in a solution of carbolic acid. 
Before throwing the dejecta into the toilet, they should be mixed with a 
solution of carbolic acid or with several spoonfuls of chlorid of lime, and 
allowed to stand for twenty minutes. Vomited matter must be similarly 
treated. For disinfecting the water after a body bath, in a case of typhoid 
or other disease, four tablespoonfuls of chlorid of lime are necessary. When 
this has been used all metallic vessels must be thoroughly rinsed off with 
water; otherwise they are liable to be attacked by the chlorin-gas. Any 
soiling of the toilet seat should be carefully cleansed with soft soap. Furs 
and leather goods can not be disinfected with live steam; they should be 
thoroughly aired, and may then be treated with one of the disinfecting 
solutions. Great importance attaches to the careful cleansing of the hands 
after having touched the patient or any objects with which he may have 
come in contact. They should be scrubbed with soap and plenty of warm 
water for at least five minutes, then rinsed, and finally immersed for from 
5 to 10 minutes in lysol or in a 1 per cent, sublimate solution. Especial 
care should be given to the cleansing of the nails. Rings must be removed 
and scrubbed, particularly on their inner surface. Personal infection may 
thus be avoided in many cases. 

A very convenient mode of disinfecting the sick-chamber together with 
the objects it contains, is by means of formalin vapor. This is done as 
follows. All openings, as windows, keyholes, cracks of the doors, etc., are 
carefully sealed with cotton rags, strips of gummed paper, or adhesive 
plaster. Drapeiies and similar articles are spread out so as to expose the 



267 


THE STANDARD FAMILY PHYSICIAN 8 S 2 £SS?*«*u~ 


greatest amount of surface. The closets are opened and the bed taken 
apart. The apparatus for evaporating the formalin, of which there are a 
number in the market, is then placed on a table in the center of the room; 
a vessel filled with water should also be provided, with a spirit lamp under¬ 
neath, so that the room may become saturated with the vapor. The door 
of the room is then carefully closed and kept so for 7 to 10 hours. The 
vapors from the formalin and the water become thoroughly mixed in the 
closed apartment, and the bacteria on the contained objects are all killed 
off. At the expiration of the required time all the windows of the room 
are opened and left so for from 3 to 5 hours, until all trace of the formalin 
vapor has disappeared. 

DISLOCATION. —The displacement of one or more bones of a joint. 
When, following a rent in the capsule of the joint, the bony surfaces are so 
much protruded that they do not return into proper position of their own 
accord, the result is a dislocation. Dislocations should be treated only by 
a physician who knows the normal position of the joints. It is necessary 
at times to administer a chloroform anesthetic to effect a reduction. The 
sooner the reduction is undertaken the easier it is achieved. The layman 
should not meddle with these conditions. The only aid he can render is 
to place the dislocated limb in a position which gives the least pain. 

The various quacks and natural bonesetters, so popular in certain local¬ 
ities, cause much harm, as they are often unable to recognize the exact 
nature of the injury. They have often mistaken and treated fractures for 
sprains, and dislocations for rheumatism, their treatment resulting in the 
partial or total inability of the patient to continue his livelihood. It is 
therefore wise to call in a competent physician in every case of injury, 

DOMESTIC REMEDIES. —The following, most prominent domestic 
remedies are arranged in different groups according to their action. 

Purges: Prune jam, one to two heaping teaspoonfuls; pure olive oil, 
one to two tablespoonfuls; castor-oil, a teaspoonful to a tablespoonful 
according to the age of the patient. Children can be induced to take castor- 
oil by sprinkling the spoon with sugar; or it may be taken with a soft drink, 
such as sarsaparilla, or with coffee. The many household teas, so widely used 
as cathartics, are not safe remedies. They usually contain senna which, used 

continuously, causes disastrous results. 

Styptics: Cleansing of the wound with pure, cold water; pressing or 
tying of pure absorbent cotton to the bleeding place. Cobwebs aie dan¬ 
gerous and unclean. 

Stimulating Remedies: Intevudlly' Acetic ether, and Hoffmann s ano¬ 
dyne, 10 to 40 drops in water or on sugar every two to thiee hours, spiiits of 
melissa, and infusion of chamomiles, one teaspoonful; stiong, black coffee, 
a small cupful. Champagne cooled in ice, and soda-water with small 
pieces of ice, taken in spoonfuls, are useful in treating nausea and \ omiting. 




Domestic Remedies THE STANDARD FAMILY PHYSICIAN 


268 


Externally: Vinegar; French brandy; Cologne water. Smelling-salts and 
spirits of sal ammoniac. 

Emetics: Irritation of the pharynx with the finger or with a feather; 
drinking large quantities of lukewarm water, soap water, or mustard and 
water. Emetics which act speedily and vigorously, such as tartar emetic, 
bluestone, etc., should be prescribed only by a physician. 

Remedies for Diarrhea: Dry claret (Bordeaux or Dalmatian); thin, 
strained decoctions of rice, barley, or oats, in tablespoonfuls. Clysters of 
starch gruel (one tablespoonful of starch mixed with a little water and then 
boiled with about half a pint of water under continued stirring). Warm 
poultices upon the abdomen. A cathartic, such as castor-oil, is advisable 
in the beginning in practically all cases of diarrhea. 

Remedies to disguise Taste: Bitter powders are enclosed in wafers, or 
taken with compotes, with fresh fruits (in a cherry or prune), in the foam 
of beer or in a sip of wine, soup, coffee, lemonade, raspberry sirup, soda- 
water, peppermint tea, etc. Bitter liquid medicines may likewise be taken 
mixed with these fluids. A bad after-taste (as of cod-liver oil or of castor- 
oil) is sometimes removed by the chewing of a crumb of bread, a roasted 
coffee-bean, or a piece of chocolate or peppermint candy. 

Cough Remedies: Warm, semi-liquid fluids in small quantities; marsh¬ 
mallow tea, one teaspoonful to a cup of hot water, after infusing for about 
one-half to one hour; malt extract, in teaspoonful doses; lime drops; 
marshmallow drops; sal ammoniac pastils, to be taken only if the irritation 
to cough is very marked. Externally: Cold compresses (which become 
warm) upon the throat and chest; inhalation of steam. Warning should 
be given against wasting valuable time by using these cough remedies. A 
physician should always be summoned at the earliest possible moment, as 
Cough (which see) may often mask a serious disease. 

Plasters: Court-plaster (to be moistened with water, not with saliva), 
used solely to cover very small cut wounds or superficial abrasions. Stick¬ 
ing-plaster is now usually bought ready for use, as the ordinary yellow 
sticking-plaster, or a very adhesive white caoutchouc plaster. Oxid of 
zinc plaster is also useful. It is unnecessary to warm the sticking-plaster 
over a flame; pressing it slightly to the skin is sufficient to make it adhere. 
Cut in strips of one-half to one inch wide, it is used to fasten bandages, or 
to cover wounds and abrasions previously cleansed and dried, or as a pro¬ 
tective covering for hard skin and callosities. If the plaster is left in place 
for several days, or if its use is continuously repeated for some length of 
time, the skin is very liable to become reddened and inflamed. A physician 
should be consulted as to whether the use of a plaster is permissible, and 
also as to whether plasters with medicinal ingredients may be employed. 
Salicylic acid plaster (so-called tourist’s plaster; corn-plaster) often causes 
a violent inflammation of the skin. Red-lead plaster, which contains cam- 











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PLATE YII 


ARTERIES OF THE NECK AND HEAD 


1 . 

Masseter muscle 

6. 

Clavicle 

2. 

Facial artery 

7. 

Occipital artery 

3. 

Common carotid artery 

8. 

Superficial temporal artery 

4. 

Sternoclidomastoid 

9. 

Internal carotid artery 

5. 

Left subclavian artery 

10. 

External carotid artery 


11. Trapezius muscle 



Plate VII 















269 


THE STANDARD FAMILY PHYSICIAN Domestic Remedies 


phor, is sold as a cure-all plaster by many druggists and quacks; it is no 
more harmful than ordinary sticking-plaster, but it is not any more effi¬ 
cacious either, and surely not in any internal disease. 

Blistering-Plasters redden and inflame the skin. If they are left in place 
for any length of time, they cause the formation of blisters; sometimes even 
of ulcers. Irritation and reddening should be the only result sought for, as 
a rule. It is advisable to remove them as soon as pain becomes noticeable. 
To allay the discomfort, cold compresses should be employed. 

Mustard-Poultice is made by mixing one to three tablespoonfuls of 
mustard powder and an equal quantity of flour with sufficient lukewarm 
(not hot) water to make a thick pulp. This is wrapped into old, fine linen 
and placed upon the skin. For small children two to three times as much 
flour or linseed meal may be admixed. The mustard-poultice should 
remain in place for about five to ten minutes. When a mustard-poultice is 
placed upon the soles of the feet, upon the calves of the legs, or upon the 
neck of unconscious persons, great care must be taken that it should not 
remain too long. 

Mustard-Paper is unsized paper, one side of which is pasted with mus¬ 
tard powder. The paper surface is immersed in lukewarm water and imme¬ 
diately put in place. Dry mustard powder enclosed in mull may also be placed 
upon the skin; the fresh or soaked dry bark of mezereon or freshly grated 
horseradish may likewise be employed as blistering-plasters. 

Salves: These are medicinal mixtures of slightly greater consistency 
than lard. Simple salves which may be used to allay pains when the skin 
is not injured are: boric acid ointment, cold-cream, rose ointment, glycerin 
ointment, spermaceti ointment, and salves of lead, zinc, and paraffin. 
Vaselin, lanolin, and ointments of boric acid, lead, or zinc, spread upon 
linen, may also be used to cover wounds. Of ointments which irritate the 
skin to a slightly greater extent, and which possess a markedly aromatic 
odor, may be mentioned rosemary, juniper, and turpentine salves. Blue 
ointment, as well as the ointments usually applied for lice, the itch, etc., 
should be used only according to a physician’s directions, as with insuffi¬ 
cient care they may give rise to extensive inflammations of the skin, and 
even to general poisoning. Rubbing too briskly may also injure the skin. 
The rubbing should be done with the palm of the hand in circular move¬ 
ments and with slight pressure. 

Sudorifics: These are medicines or other agents that produce sweating. 
Perspiration is often very beneficial in slight affections due to cold, such as 
nasal catarrh, violent pains in the limbs, or lumbago; but it must not be 
exaggerated and continued for several nights. To produce perspiration it 
is often sufficient, in those who are not accustomed to it, to cover them with 
a feather bed. The effect is assisted by the drinking of various hot drinks 
such as hot lemonade, weak tea with lemon-juice, or infusions of elder- 





Dover’s Powder 
Dress 


THE STANDARD FAMILY PHYSICIAN 


270 


flowers, chamomiles, peppermint, or melissa. These teas are prepared like 
ordinary tea, and one or two cups are taken (with sugar) before retiring. 

DOVER’S POWDER (PULVIS IPECACUANHA ET OPII). —A com¬ 
pound powder consisting of ten parts of ipecac, ten parts of opium, and 
eighty parts of sugar of milk. It is used as a pain-allaying remedy in 
many non-febrile affections. In dysentery and diarrhea its action is often 
very grateful. The dose is from 5 to 15 grains. A warm drink taken after 
the dose insures more rapid action. 

DREAM. —Our mental activities are not suspended during sleep, and 
the connection between sleeping consciousness and waking consciousness 
is not entirely interrupted. We usually dream of things that we have 
busied ourselves with while awake, and our sense perceptions go on to a 
certain degree. Two characteristics, however, differentiate dreaming states 
from wakeful states: in the first place, the fantastic transformation of the 
sense impressions; and secondly, the confusion of the course of thought. 
Free, easy breathing creates in the dreamer an impression of flying; heavy 
breathing creates a feeling of fear; splashing rain becomes a flood; a fly 
bite a dagger thrust; a hot water bottle, a promenade in the tropics; the 
buzzing of a fly, a hurricane; a gleam of light, paradise and all its angels; 
the uncovering of part of the body, a sleigh ride; etc. The confusion of 
the course of thought causes the abrupt changes of the dream visions. The 
picture changes without interruption and without causing any surprise. 
This incoherency in the train of thought, and the lack of judgment it car¬ 
ries with it, refers also to ideas of time. Dreams which last only a few 
seconds or minutes may appear to last an eternity. 

Whether deep sleep is dreamless, as is claimed, seems doubtful, even 
improbable. The dreams of light sleep are generally more senseless and 
disjointed than those of deeper sleep, in which entire dramatic scenes may 
be reproduced. Movements of the muscles are not a rarity in dreaming 
states. Generally they are the muscles of speech and of the face (speaking, 
laughing, and crying during sleep); but at times other muscle groups 
become active, and in such cases the dreamer will get out of bed, walk 
about, and perform customary tasks. After awakening, there is no remem¬ 
brance of what has gone before. These cases are instances of somnam¬ 
bulism. Many stories are told about these somnambulists. The most 
wonderful feats are ascribed to them; for instance, walking along the ridge 
of the roof of a house. Most of these stories are fictitious, but it can not be 
entirely gainsaid that somnambulists at times evince remarkable dexterity. 
This is explained by the fact that the dreamer’s consciousness is limited, 
and that his attention is directed to such an extent to a given undertaking, 
that the thought of a dangerous position, which would at once arise in the 
wakeful mind, falls aside. Somnambulism is also called moon-sickness; 
but the moon has very little to do with the condition, excepting that its rays 




271 


THE STANDARD FAMILY PHYSICIAN 


Dover’s Powder 
Dress 


of light, entering the sleeper’s room, may cause dream impressions in him. 
Any other light (for instance, a lamp light) has the same effect. 

The intrepretation of dreams has always played an important role in 
the history of mankind; particularly the interpretation of such dreams as 
presage sickness or death. Superstition has had full sway in this domain, 
but there is nevertheless some truth in the popular notion. Sometimes 
certain physical disturbances are felt while dreaming, which have not been 
noticed while awake. For instance, a hitherto unnoticed disturbance of 
circulation in the leg may appear in a dream to be an inflammation, this 
latter condition actually occurring a few days later. However, it is wise to 
be cautious about such prophecies; and even more so regarding dreams 
premonitory of coming misfortune, etc. Chance and a fallacious memory 
may be important factors. 

DRESS.—The principal object of dress is to provide the body with a 
necessary amount of heat. Although this object of dress has ever been the 
most essential and the original one, it is scarcely possible at the present 
time to separate the question of utility from that of adornment; and it is 
only too often the case that usefulness is made subservient to the dictates of 
fashion. Changes of the weather, especially those of temperature, compel 
us to direct our attention to a rational mode of dressing, thus to assist the 
heat-regulating activity of the skin. With respect to this it is true that 
great differences exist in different individuals. Some people, for instance, 
may feel comfortable in clothes which others could not wear without danger 
of catching cold. The elementary materials of our dress are derived from 
the animal kingdom (wool, silk) or from the vegetable kingdom (linen, 
cotton). These can be distinguished readily by the eye alone. The sim¬ 
plest method to distinguish between wool and silk on one hand, and linen 
and cotton on the other, is by the test of burning. Wool and silk, when 
ignited, smell like burnt horn; linen and cotton about like burnt paper. 
With the aid of a microscope and of certain chemical expedients, it is easy 
to distinguish the chief textile fabrics. 

The most important object of dress from a hygienic standpoint is to regu¬ 
late the amount of heat that is given off from the skin. Clothing limits the 
amount of heat lost in cool surroundings, and allows the ready passage of 
the heat which is constantly formed in the body. But the human body not 
only gives up heat to the surrounding air, but water, in the form of invisible 
vapor, as well. The amount of aqueous vapor given off varies with the 
temperature, the muscular activity, and the amount of humidity of the 
atmosphere. If large quantities of water are given off, it appears not in 
the form of vapor, but in drops, as perspiration. The clothing should not 
offer any resistance to this giving off of water; and lor this reason it should 
be porous, so as to allow the passage of air. L ndoubtedly great differences 
are to be noted in the heat-retaining properties of the various fabrics. 






Dress 


THE STANDARD FAMILY PHYSICIAN 


272 


Experience teaches that a woolen shawl retains the body heat better than a 
cotton or linen one. The property of being able to retain the body heat is 
not due to the substance of the fabric, but is rather a property of its mode of 
weaving. A right proportion between the amount of substance and the 
size of the mesh determines the quality with reference to the retaining of 
heat and moisture. A second factor is found in the thickness of the fabric. 
In keeping with their lesser air content, the smoothly woven fabrics retain 
the heat the least; tricot materials more, and flannel fabrics the best. There 
is a very large amount of air space (about y 9 ^- of the whole) in flannel 
fabrics. 

Although it follows that the heat-retaining quality of the various fabrics 
is determined especially by the nature of the weave rather than of the sub¬ 
stance, there are certain qualities which do not render them equally suitable 
to be manufactured into textures. Wool can be woven into the loosest 
textures, whereas vegetable fibers are less well adapted for this purpose. If 
the conditions of looseness and of thickness are of especial importance when 
it is a question of protection from loss of heat in cold surroundings, the 
porosity of the fabric is of particular moment in hot temperatures. Prob¬ 
ably every one has experienced the oppressing sensation of being overheated 
during the hot summer months when the air is very moist. How does this 
sensation arise? The body rids itself of its own heat by conduction, by 
radiation, and by the evaporation of water. The loss of heat by the evapo¬ 
ration of perspiration is especially important. Restriction of this function 
leads to an overheating of the body; sometimes even to an accumulation 
of heat with dangerous consequences (see Heat-Stroke). The evapo¬ 
ration of water from the skin is retarded especially when, in addition to the 
customary outer garments, closely woven fabrics such as smooth linen or 
cotton textures are worn as undergarments. As already mentioned, these 
contain a comparatively small amount of air; hence, they do not retain 
heat. This of itself would be an advantage during the hot weather. But 
this advantage is more than outweighed by their inferior porosity, since 
such textures offer considerable resistance to the evaporation of water 
from the skin. This causes a ready formation of perspiration, which soon 
clogs up the few air-pores of the garment and completely hinders further 
evaporation. 

But this is not all. The linen or cotton texture, fully saturated with the 
water of perspiration, no longer contains any air; hence, it does not retain 
heat at all. This condition does not cause any inconvenience so long as 
the individual remains in a heated atmosphere, but he will feel the annoy¬ 
ance thereof the moment he passes into a cooler place. Experience has 
taught the necessity for being cautious when cooling off after strong perspi¬ 
ration. Any one dressed in garments of loose texture will in such an instance 
run much less risk of catching a cold than a person who wears clothes of 




273 


THE STANDARD FAMILY PHYSICIAN 


Dress 


smooth texture. The latter, rendered airless by the accumulation of sweat, 
act in an extremely cooling and refrigerating manner. The fabric of loose 
texture may also absorb sweat, but this soon evaporates through the pores 
of the garment, and it is only in the rarest cases that all the pores become 
filled with water. Sufficient air will almost invariably be retained to pro¬ 
tect the skin from too sudden loss of heat and, therefore, from excessive 
exposure. 

The following general principles regarding a rational mode of dressing 
can be deduced from the above statements. The essential point is the 
correct selection of undergarments. These should be made of a loosely 
woven fabric (for instance, tricot weave) which should be selected heavier 
in winter, lighter in summer. Smooth, closely woven linen and cotton 
fabrics are not suitable; the starched bosom shirts used by men are espe¬ 
cially out of place, as the starching renders them absolutely unporous. It 
is not sufficient, however, to secure loose, porous underwear, as the favor¬ 
able effects provided by it can be counterbalanced by closely woven, unpor¬ 
ous outer garments. The smooth, thin, woolen fabrics which are preferably 
worn as outer garments in summer, are harmless in this respect, as they are 
still sufficiently porous; the same applies to the more loosely constructed 
winter fabrics. But the material used for linings is generally quite unfavor¬ 
able for ventilation, and its removal or displacement by other, more porous 
material would be desirable. With changeable temperatures, a sensibly 
dressed person regulates his requirement of heat and cold by a correspond¬ 
ing change in his outer garments, wearing the same underwear. With 
regard to undergarments the question remains to be decided whether loosely 
woven woolen, cotton, or linen fabrics should be preferred. As is well 
known, every one of these materials has had its advocate in its time. Jager 
extolled woolen garments as the only correct ones; Lahmann defended 
cotton; and Pastor Kneipp favored linen fabrics. The discussion already 
outlined shows that a so-called “normal dress,” suitable for all conditions 
and based upon a certain elementary substance, does not exist. The only 
rational dress is one which is adapted to the changing external and bodily 
conditions. However, it can not be denied that wool possesses certain 
advantages over the other elementary substances. The fine little fibers of 
wool act as supporting hairs, creating a kind of insulating layer of air 
between the skin and the undergarment. Some persons, however, can not 
wear wool next to the body because their skin is very sensitive. Wool ab¬ 
sorbs water only incompletely, and therefore remains dryer; it absorbs the 
secretions of the skin well, and it is lighter than garments made of vegetable 
fibers. Other mystic qualities, such as are ascribed to it by Jager, wool 
does not possess. On the other hand, these superiorities of woolen garments 
are counterbalanced by certain disadvantages. W oolen fabrics are soon 
worn out, and they soon become dirty. To combine the favorable pioperties 





Dress 


THE STANDARD FAMILY PHYSICIAN 


274 


of animal and vegetable fibers, mixed fabrics are now manufactured which 
are well adapted for porous underwear. 

The question of cleanliness is one which is apt to clash with the principles 
here described, and it is probable that for this reason smooth, closely woven 
linen and cotton fabrics can never be discarded entirely. These materials 
are suitable, above all, for outer garments; primarily in surroundings where 
protection from dust is desired. For use in the summer, as well as in the 
household and for nursing, white, smooth cotton garments, worn over porous 
underwear, are hygienic and clean. As darker materials absorb more heat 
from the sun’s rays than lighter ones, the color of the clothes also plays a 
small part; and for this reason alone white linen and cotton outer garments 
must not be underrated. 

In addition to these more general considerations, some special questions 
of dress need discussion. With regard to the cut of the outer clothes this is 
well known to be subject to fashion. From the hygienic standpoint, fashion 
is harmless as long as it does not lead to an unnatural or unsanitary com¬ 
pression or uncovering of certain parts of the body. Generally speaking, 
comfortably fitting garments are naturally preferable. For certain pur¬ 
poses it appears serviceable and practical to make the clothes waterproof; 
but garments that are made completely waterproof by a covering of caout¬ 
chouc or varnish are by the same process rendered absolutely unporous, 
and are not beneficial to health, for reasons already stated. Such garments 
should, therefore, be used temporarily only. A fair protection against 
drenching is, however, afforded by clothes impregnated with certain other 
substances, which partly preserve the porosity of the material. 

Another question is whether the numerous dyestuffs used in fabrics may 
all be considered harmless. By far the majority of them may be used with¬ 
out detriment to health. Some of the injurious ones, as those containing 
arsenic, are forbidden by law in certain communities; others, containing 
chrome, antimony, or anilin, are not very likely to cause poisoning from the 
skin, and do not, therefore, deserve much attention. Occasionally poison¬ 
ing has occurred in the skin of the feet from new stockings. 

The usual head covering is generally rather too warm than too cool, at 
least that which is used by men. In so far as it is a question of combining 
porosity with waterproof qualities, the establishment of at least a moderate 
ventilation by air-holes should be taken into consideration. Fur caps 
should be worn only in very cold weather. In summer, as is well known, 
a light covering for the head is most desirable. Light straw hats perforated 
on the sides, or light white caps with air-holes on the sides answer the pur¬ 
pose. In a scorching sun, the back of the head and the nape of the neck 
should be protected. To guard the eyes from the dazzling rays of the sun 
it is of advantage to wear wide-brimmed hats, or caps that are shaded in 
front. 






275 


THE STANDARD FAMILY PHYSICIAN 


Dress 


Garments that constrict the neck should be avoided, as they may impair 
the normal circulation of the blood to the head. The dictates of fashion 
unfortunately often favor tight-fitting collars for women’s apparel; and 
certain excessively high collars worn by men are not much better. The 
free exposure of the throat and of the upper part of the chest may become 
quite as harmful. 

Experience teaches that it is of great importance to keep the abdomen 
warm. Offenses against this rule are often accentuated by disturbances 
of the digestive organs. Here, too, the susceptibility of different persons 
varies considerably, and for some people it may be advisable to wear an 
abdominal bandage during the cooler seasons. In temperate climates the 
limbs, no less than the other parts of the body, require the protection of 
garments. In a certain respect they require it still more, as they are situated 
at greater distances from the heart, and may occasionally suffer from a 
diminished blood supply. This is not the case so long as the limbs are 
vigorously exercised; but if the mode of living is such that the body is 
often at rest, the circulation of the blood sometimes becomes impaired, 
and the heating of the extremities insufficient. While an incomplete cover¬ 
ing of the arms and legs is not often encountered in adults, it is frequently 
customary to allow children to be about with naked arms and with partly 
uncovered legs. In cold weather this is not advisable. 

The use of gloves appears to be appropriate only under certain condi¬ 
tions; especially during the cold season to prevent affections of the hands 
or of the tips of the fingers by frost-bites. It is well known, however, that 
in a great number of cases the winter-glove accomplishes the opposite of 
that for which it is intended, and by constriction of the blood supply more 
than favors the numbing of the fingers. In order to be actually warming, 
gloves must be very wide, and should preferably be mittens. The thicker 
the gloves are, and the more airy and loosely woven their texture, the 
warmer they will keep the hands. 

Whereas the hands are kept covered only exceptionally, the constant 
covering of the feet during the day is customary. The clothing of the feet 
is intended for a twofold purpose. It should prevent the pronounced loss 
of warmth which arises when the foot touches the cold earth; and it should 
protect the foot from injuries, wet, and dirt, and impart to it a certain 
firmness. Stockings protect the feet against overheating, and form a kind 
of yielding bolster during walking. As shoes and stockings together are 
only slightly porous, diminution of evaporation occurs, and in consequence 
there is usually excessive sweating. In cases of insufficient cleanliness the 
latter, together with the cast-off particles of the skin, decomposes and gives 
rise to the notorious disagreeable odor of perspiring feet. This abnormal 
sweat formation occurs to a very annoying degree in some persons who ap¬ 
pear to be predisposed in this direction. This alfection can best be pre- 





Dress 


THE STANDARD FAMILY PHYSICIAN 


n g 


vented by scrupulous cleanliness (daily foot-baths) and by the wearing of 
porous, absorbent stockings. At the same time it is advisable to wear 
perforated shoes or sandals whenever possible; for instance, at home. 
More marked sweating of the feet requires treatment by a physician. Rub¬ 
ber shoes, which still more restrict the evaporation of the covered foot, 
should be worn only temporarily, and should always be taken off as soon as 
possible. 

As to the form of the shoes, it is a well-known fact that for the most 
part they do not correspond to the shape of the feet, therefore they press 
the latter into constrained positions which may lead to deformities (dis- 



Fig. 107. Deformity of foot due to badly fitting shoe. 


placement of the big toe toward the side of the small toe; see Fig. 107) and 
to a number of troublesome conditions (corns, ingrowing nails, etc.). The 
sole is shaped correctly only when a line which passes through the middle 
of the big toe, running parallel with the latter, strikes the middle of the heel. 
The uppers also must be worked highest in the course of this line, and 
the forepart of the shoe must adapt itself to the form of the toes. However, 
as most “hygienically constructed” shoes present a very clumsy appearance, 
there is very little prospect of their becoming generally adopted. The prob¬ 
lem of making hygienic shoes of becoming appearance has, however, been 
fairly well solved by the American shoemaker. Laced shoes are preferable 
to those with elastic sides, as the latter may impair the circulation of the 
blood. The heels should not be too high. 

If the male dress is not fully in keeping with the requirements of hy¬ 
giene, this, as is well known, is still much more the case with the female 
dress. That part of the female dress which has ever given rise to criticism 
on the part of the medical profession, is the corset. It is claimed that Queen 
Elizabeth invented it to cover the deficiencies of her figure. In c ther respects, 
the principal object of the corset is obviously to cause the female sexual 
characteristics to become more conspicuous. The history of the corset is a 












277 


THE STANDARD FAMILY PHYSICIAN 


Dress 


classical example showing what fashion is able to do, and how unrelentingly it 
can enslave its followers, especially the female sex. It is very remarkable, 
that to a great number of women the most conspicuous and most variegated 
costumes are not obnoxious, whereas another pattern of dress, which is 
not in style but more sanitary, is detested by them as disagreeably osten¬ 
tatious. And, finally, the excuse is always given: “What has done no harm 
to our mothers, will not prove injurious to us either; hence, let us continue 
the old habits.” This view can be explained only by the fact, that but a 
very small number of women have even the slightest idea of anatomical 
conditions, and are in no way aware how they injure the organs of their 
body. As custom renders everything bearable, it is probable that the 
originally annoying pressure of the corset is no longer, or only occasionally, 
felt. 

Tight lacing exerts a manifold, harmful influence upon the female body. 
The lower part of the bony thorax is compressed (see Fig. 33); and the 
muscles of the back and of the belly are squeezed and thereby weakened. 
The internal organs naturally also give way to the pressure, and try to find 
another place. The liver, stomach, and intestines are pressed downward; 
the activity of the diaphragm, so important to respiration, is restricted; 
and the lower parts of the lungs are prevented from proper expansion. 
This general constriction causes, further, an impairment of the large blood¬ 
vessels which maintain the circulation between the upper and lower halves 
of the body. In short, not only the most vital function, that of respiration, 
is disturbed; but also the circulation of the blood and the digestive functions 
are interfered with. In addition, the forcing downward of the intestine is 
very liable to cause displacements, inflections, and dragging of the internal 
female genital organs. A host of affections of girls and women owe their 
existence directly or indirectly to tight lacing. 

Especially marked, and conspicuous even to the eye of the layman, is 
the influence of tight lacing upon the liver. As every physician has had 
opportunities to observe at autopsies, the liver of a female corpse often shows 
an indentation in the region of the waist (tight-lace liver). Still more, tight 
lacing may even give rise to almost complete separation of some of the lower 
portions of the liver. It is obvious that also the gall-bladder, which is situ¬ 
ated behind the lower border of the liver, frequently suffers by pressure, 
which favors the formation of gall-stones. Since it is certain that there 
is often a causal connection between gall-stones and the development of 
cancerous tumors of the liver, and since the latter diseases occur relatively 
much oftener in women than in men, it is undoubtedly permissible in many 
cases to ascribe the fault to the corset. 

Similar symptoms as those produced by tight lacing may occur also if 
the bands of the skirts are drawn too tight (see Fig. 108). In general, women 
carry the weight of their dresses on the wrong parts of the body. The prin- 






Dress 


THE STANDARD FAMILY PHYSICIAN 


278 


cipal weight of the dress should be borne by the shoulders; not by the hips. 
In most women the covering of the lower half of the body is much too 
heavy, owing to the customary numerous petticoats. 

But how is the corset to be replaced? A substitute for the corset must 
not in any way press upon any organ of the body. On the other hand, 
it must give sufficient support to the breasts, and be suitable to hold the other 



Fig. 108. Constriction due to tight waistband. 


undergaments. For these reasons, shoulder-bands are indispensable. The 
number of advertised corset substitutes is a very large one, and we can 
not here enter upon details. 

The reform of female undergarments is a question which is closely con¬ 
nected with this corset reform. It has been said that the weight of the 
former is usually excessive, and that their fastening by binding is not prac¬ 
tical. They should rather be fastened by buttoning them to the bust- 
holder. But, to do this, the undergarments require to be simplified. In 
place of the petticoats closed bloomers have been recommended, if neces¬ 
sary with drawers that can be buttoned into the same; and in place of 
undershirt and drawers, the so-called combination-suits (see Fig. 109). 


/ 

















279 


THE STANDARD FAMILY PHYSICIAN 


Dress 


All these innovations would diminish the weight of the dress without im¬ 
pairing its warming effect. Closed drawers possess obvious advantages 
over the undergarments formerly in use, especially with reference to keeping 
warm. Stockings should not be fastened by round garters over the calves, 
but should be attached by aid of hose supporters to the corset substitute; 
otherwise, in consequence of constriction of the blood-vessels, the garters 
are apt to cause congestion of blood in the legs (varicose veins). 

In a rational dress for women, at least the street dress should not reach 
down further than to the shoe tops. Apart from the comfort of the wearer, 

sanitary view-points are determining in this respect. 
Trailing skirts whirl up the dust, which is generally looked 
upon as something injurious to health, as it is conducive 
to a dissemination of disease-germs (especially tubercu¬ 
losis) which may enter the respiratory organs. A lively 
agitation against allowing the wearing of trailing skirts 
in the streets has therefore become manifest in many 
places; and it 
has been sug¬ 
gested to abolish 
the nuisance by 
city ordinances. 

Conceive the 
amount of filth 
brought into the 
house by the 
edge of the skirt 

Fig. 109. Practical of a fashionable 
combination-suit. . 1 . ^ , 

lady! Ought 
not the sense of cleanliness alone 
—quite apart from all hygienic 
considerations—object to this nui¬ 
sance? 

These are the principal points 
in which women sin with regard 
to their dress. Two others, less 
important ones, may be briefly 
mentioned. While nowhere else 
the outer garments (which as a 
rule are not washable) are worn 
near the bare skin, the waist is 
worn day after day over the bare 
arms and neck, and the upper 

part of the breast. The necessary F ig. no. Ideal mode of dress. 








































Dropsy 

Drowning- 


THE STANDARD FAMILY PHYSICIAN 


280 


consequence is that it gradually becomes greatly soiled in these places. 
Further, the wearing of a veil is a superfluous fashion which is harmful to 
the complexion. That the skin of the face becomes rough and abnormally 
red (especially the point of the nose) is, not wrongly, ascribed to this fash¬ 
ion. Neither is the veil without harm to the eyes. See Eye, Care of. 

To combat fashion with logic is generally a vain undertaking. It 
would, besides, be quite unjustifiable to ask women to surrender many 
of their little decorative means simply because they are not quite ap¬ 
propriate. But the gross transgressions of fashion against health should 
be combated by every one. That this struggle need not always be carried 
on at the expense of what is beautiful and pleasant—assuming earnest 
intentions and endeavors—is probably certain; and, finally, the conception 



of what is beautiful and pleasant in the dress of woman is exceedingly 
changeable. It is certain that many fashions which at first impressed us 
as the strangest, appeared not only bearable, but often even becoming, 
after a short time of habituation. 

DROPSY.—A condition in which the fluid portion of the blood escapes 
from the blood-vessels and collects in the body-cavities or under the skin. 
It may appear in the course of many diseases, owing perhaps to a sluggish 
condition of the blood caused by impairment of the propulsive power of 
the heart or by other disturbances, or owing to the fact that the walls of 
the blood-vessels have become permeable on account of faulty nutrition. 
In such cases the serous fluid exudes in large quantities and collects in various 
parts of the body. According to the part of the body affected, this causes 
dropsy of the brain (see Hydrocephalus), of the skin, of the chest (see 
Chest, Dropsy of), of the pericardium (see Hydropericardium), or of 
the abdomen (see Ascites). Dropsy is therefore not a specific disease, 
but always a symptom of another disease; and consequently the treatment 
always depends upon the original disease, upon the nature of which depends 
in turn the possibility of permanent or temporary alleviation of the edema. 

The laity is in great dread of this “water.” But as in many cases these 
dropsical swellings can be cured with proper treatment, there is no need to 

































281 


THE STANDARD FAMILY PHYSICIAN 


Dropsy 

Drowning 


be uneasy about them or to arouse a feeling of anxiety in the patient’s 
mind. 

DROWNING. —Any one in danger of drowning should at once turn on 
his back, bend his head backward, and extend his arms on the water, not 
above it. He should keep his lungs filled 
with air by making deep inspirations and 
short expirations. The attitude in which 
he will best keep himself floating is shown 
in Fig. hi ; whereas the raising of the arms 
(see Fig. 112) should be avoided, as it 
causes the head to sink below the surface. 

A rescuer who is unable to swim should 
hold out some object (as an oar or a pole), 
or throw a life-preserver or a rope to the 
drowning; if none of these objects is at 
hand, he should try to reach the unfortu¬ 
nate by the aid of a coat-sleeve or by a 
rope formed by tying together other parts 
of his dress. If the rescuer is a swimmer 
he should grasp the drowning person by the 
hair, turn him on his back, and swim toward 
the shore holding the body with both his 
hands, he himself swimming on his back. 

If some one has broken through the 
ice and is unable to help himself because 
the edge of the ice is continually breaking, a ladder, a long pole, or a 
board should be pushed toward him (see Fig. 113). If the distance is 
too great, two ladders may be used by being pushed alternately forward 



Fig. i i 2. Incorrect position in water. 



Fig. 113. Attempt to reach a man who has broken through the ice. 


(see Fig. 114). In the absence of these expedients it is advisable to crawl 
toward the drowning as soon as the weak portion of the ice is approached, 
































































































































Drowning- 
Dust Diseases 


THE STANDARD FAMILY PHYSICIAN 


282 


or at least to place a long stick or an oar across the back, holding it with 
both arms. In case of breaking through the ice, this stick will prevent 
drowning (see Fig. 115). 

A person in danger of death by drowning has either a bloated, bluish- 
red appearance, with bluish lips, bloodshot eyes, and slime in his mouth, 



Fig. 114. Use of two ladders in attempt to rescue a person who has broken through the ice. 

or he is pale and in a deep faint. Even when a drowned person has been 
under water for some time, it may be possible to resuscitate him if the 
attempts are continued for hours. In the first place, his mouth should be 
opened wide by pressing down the lower jaw; and dirt, sand, and water 



should be removed by introducing the finger deep into the throat. At the 
same time vomiting should be induced by tickling the pharynx. The body 
is placed upon the belly, and a roll prepared from clothes is pushed under 
the pit of the stomach. This is at once to be followed by Artificial Res¬ 
piration (which see). 
















































































































































283 


THE STANDARD FAMILY PHYSICIAN 


Drowning- 
Dust Diseases 


DRUNKENNESS. —See Alcoholism. 

DULCAMARA.— The bittersweet, or woody nightshade (Solanum dul¬ 
camara ), a trailing plant widely distributed throughout North America. 
The parts used in medicine are the dried, young branches of the plant, 
which has a bright purple, potato-like flower, with scarlet fruit, often called 
the wolf-grape, or poison-berry. The active principles of the plant are 
glycosides, and it has some of the poisonous qualities of belladonna and of 
other members of the nightshade family ( Solanacece ), notably of solanin , 
the action of which is sometimes present in sprouting potatoes. Poisoning 
by this drug causes nausea and vomiting, intense prostration, and some 
signs of destruction of the blood. 

DUMBNESS. —See Speech Disturbances. 

DUST DISEASES. —Inflammatory diseases caused by the inhalation of 
large quantities of dust. Persons who are engaged in certain callings in 
which they are continuously surrounded by an atmosphere of dust are es¬ 
pecially liable to contract such diseases. If there is no increased inhalation 
of dust it is generally thrown off again. Some of the dust particles remain 
on the moist mucous membranes of the nose, of the pharynx, and of the 
throat; others are caught up and deposited on the protruding surfaces of 
the turbinated bones, or on the ever present deviations and deflections of 
the septum, and are finally deposited in the pharynx which turns downward 
almost at right angles with the nose (see Fig. 47). When dust reaches the 
bronchial subdivisions through the glottis, the small ciliated cells which 
rest in rows on the mucous membrane of these parts are able to throw out 
the dust particles by aid of their small hairs which move outward in the di¬ 
rection of the mouth. In the construction of the respiratory passages 
there lies a natural protection against the inhaling of dust. The inhaling 
of quantities of dust, especially if heavy and injurious, causes the respiratory 
organs to lose this natural means of protection, and inflammation sets in, 
which often extends from the nose into the lungs. A constant catarrh of 
the nose, throat, larynx, and bronchial tubes is characteristic of persons 
who work in dusty places. 

The typical “dust lung” is of rare occurrence. In such a lung the 
spongy tissue is gradually transformed by the foreign bodies into a firm, 
cicatricial mass. Occasionally these parts, thus cut off from the circulation, 
die off and soften. If this process involves the bronchus, the softened mass 
is coughed up and a lung cavity results. If a blood-vessel is involved, there 
follows a hemorrhage of the lungs. Thus, in consequence of the effects of 
dust, changes resembling consumption may take place in the lungs, with 
the exception that there are no tubercle-bacilli in the sputum. Experience 
shows, however, that in these conditions of the lung such bacilli are easily 
deposited, and settle on the lung. It is a fact that persons doing dusty work 
are more often afflicted with consumption than any other class of people. 







Dwelling-Places THE STANDARD FAMILY PHYSICIAN 


284 



Fig. i i 6 . Device for protection against 
inhalation of dust. 


The first aim of factory hygiene should be directed toward overcoming 
the diseases caused by the inhalation of dust. No industry claims more 

victims, and causes more injury to health, 
than one in which the workers are exposed 
to the inhaling of dust. It must be ad¬ 
mitted that this is not an easy task; yet the 
provisions made by the state and by the 
manufacturers in this regard are by no 
means perfected. Special endeavors should 
be made to provide large, airy workrooms, 
which must not be overcrowded; to have 
the raw materials moistened; to have work 
which creates dust performed in closed 
compartments; to dismantle dusty places, 
removing the dust; and finally, as a last 
resource, in cases where the removal or 
suction of dust is impossible, to make use 
Oof respirators (Fig. 116), damp sponges, 
and the like, which are tied to the nose and 
mouth, excluding dust mechanically. 

If health becomes impaired from doing 
dusty work, an early change of occupation 
should be made; a later change is often impossible if for no other reason than 
that of economy. 

DWELLING-PLACES. —Man’s comfort, his happiness, and the health 
of his family depend to a great extent upon the character of his dwelling- 
place. A dark, narrow, dirty, and noisy house is not conducive to con¬ 
tentment, and is often the reason why a man, instead of finding his center 
of attraction in his home and family, seeks it outside of the home—in 
the drinking-house, or in a place of amusement. The living-place is there¬ 
fore one of the things in life which is most unsuited for the practise of 
false economy. 

When choosing a dwelling-place, the following points should be borne 
in mind: An elevated portion of the city is to be preferred, on account of 
being dryer and airier. The upper stories of a house are generally lighter, 
and more airy and quiet than the lower ones. The dwelling-place ought 
not to be too far distant from the place of employment, nor from the school, 
unless it is in easy and inexpensive connection with these by trolley or other 
means of transit. The vicinity of badly smelling or noisy factories should 
be avoided if possible. Regarding the light exposure, see the article on 
Light. It is possible to take all these things into consideration, even in 
cases where the pecuniary aspect is an important factor. 

The dwelling-place should have a well lighted entrance, but not a steep 










285 


THE STANDARD FAMILY PHYSICIAN Dwelling-Places 


one. Houses with dark stairs can not be kept clean, and, the atmosphere 
not being pure, such houses are hurtful to live in. The number of available 
rooms must depend upon the individual means. The sleeping-rooms must 
be chosen with special care, not so much so the living-rooms or the working- 
rooms. Too much stress can not be laid upon the importance of the sleeping- 
room being the largest, sunniest, and airiest room in the house; for the greater 
part of one’s life is spent in that room. Unfortunately, even among the 
wealthy classes, the best rooms are chosen for show rooms, and are sacrificed 
to the comfort of visitors; whereas the rooms chosen as bedrooms (which 
are not seen by the visitor) are often the most miserable holes, lacking light 
and ventilation. But the penalty comes in the shape of doctor’s and drug¬ 
gist’s bills. The minimum quantity of air in the bedrooms of children 
under ten years of age should be 5 cubic meters; for adults it must be twice 
as much. The soldier in the barracks is allowed 15 to 16 cubic meters of 
air space. Where servants are kept, these also should have decent, healthy 
sleeping-quarters. This is a matter of course, but one which unfortunately, 
especially in large cities, is neglected both in regard to the construction of 
the houses and the disposition made of the rooms by the occupant. 

Basement dwellings are often dark, and are damp and gloomy owing to 
insufficient ventilation. A basement built with substantial, independent 
walls, with a light-shaft reaching to the foundation, and having large, high 
windows, is less objectionable. Attics are hot in summer on account of 
their thin walls, and cold in winter. They cause greater mortality among 
young children than any other kind of living-place. 

The walls of rooms may be covered with paper, or painted. In new 
buildings the walls should not be covered until at least one year after their 
erection. If covered sooner, the great quantities of moisture which enter 
the walls while the building is in construction can not evaporate; and the 
covering greatly retards the drying of the walls, which in consequence 
become damp and moldy, and contaminate the air with their musty odor. 
Instead of being papered, the walls of a new building may be painted with 
water-colors, which do not interfere with the drying and which give the 
rooms an agreeable appearance. 

Arsenic poisoning from wall-coverings was formerly not a rare occur¬ 
rence, when these were manufactured with arsenic dyes. At present such 
a possibility exists only in rooms where a new covering has been pasted 
over an old one containing arsenic. It is advisable every two years to clean 
off wall-papers with bread. This will show how much dust and dirt has 
accumulated on the paper. 

The floors of houses should be smooth and have close seams. Broad 
seams favor the accumulation of dust, and allow the scrubbing-water to 
run between the ridges where it may decompose and cause a disagiecablc 
odor. The best flooring is one made of parquetry embedded in tar. Stone 





Dwelling-Places 

Dyestuffs 


THE STANDARD FAMILY PHYSICIAN 


286 


floors are cold; and like poor wooden floors they should be covered with 
linoleum, at least in the living-rooms and sleeping-rooms. 

The cause of dampness is not always easily established, but if depending 
upon poor construction it can be remedied only by alterations in the structure 
of the building. In such a case it is best to consult an authority, and not 
follow the advice of interested business people who may advise some “un¬ 
failing” remedy. Dampness frequently results from some improper ar¬ 
rangement in a house. Rooms with thin walls will always be damp in winter 
if not sufficiently heated, for the moisture in the atmosphere of the room 
will condense on the cool walls. When a number of persons are together 
in a room, this dampness will be increased by the moisture which they throw 
off in breathing. Among the poorer classes, dampness in dwellings is often 
caused by allowing the doors connecting the living-rooms with the kitchen 
to remain open for the sake of utilizing the heat from the range. The 
moisture from the cooking and washing pours from the kitchen into the 
adjoining rooms and condenses on the walls. During the first days of 
spring, ventilation should be undertaken very carefully, as the damp atmos¬ 
phere of that season deposits moisture on the walls of poorly heated rooms 
and makes them damp. Heating should, therefore, not be discontinued 
at the first approach of spring, but should be continued moderately, with 
an additional thorough ventilation. 

Newly constructed houses are always damp, even when they appear to 
be dry. The only advantage they possess is that they have not been lived 
in like old houses. For reasons of health, however, occupancy is advisable 
only after a certain degree of drying, and then only with careful heating 
and ventilation in the winter time. When heating new houses, the win¬ 
dows must be kept closed; the air is renewed by repeatedly opening the 
windows and doors for a few minutes at a time. While ventilating the rooms 
a steady heat should be maintained so that the incoming dampness may be 
carried off. 

Every dwelling-place should have its own closet, which should be fur¬ 
nished with a window for light and air. If several households have one 
common closet, each family is apt to depend on the next one to keep it clean. 
Dark closets are not easy to keep clean, and those without windows con¬ 
taminate the atmosphere of the houses. The most hygienic closets are those 
with running water. Where such can not be introduced, earth closets 
are the next choice; provided, of course, that earth is really strewn, a process 
which unfortunately is generally neglected after a time. 

When the bathroom is furnished with a gas stove, this must be fitted with 
a pipe to carry off the gaseous products of combustion. The lack of such 
a waste-pipe has frequently caused poisoning (at times fatal) in consequence 
of the inhalation of the combustion products, even if in other respects the 
stove was properly cared for. 




287 


THE STANDARD FAMILY PHYSICIAN Dye8tJ3fs Place8 

Even the smallest dwelling-place ought to have one cool closet for the 
preservation of articles of food. This is especially necessary in the summer 
time in order to keep boiled milk fresh for the children, as a decomposition 
of this article of food may have dangerous consequences. See Cholera 
Infantum. 

The relation between dwelling and disease may exist in various ways. 
The harmful effect upon the health of the occupants of dwellings which lack 
air and light, and which are overcrowded and dirty, is so well known that 
it needs no further elaboration. Children especially suffer under such 
conditions. The same applies to dampness. Damp walls always cause 
a feeling of chilliness, because they condense moisture in the rooms and 
draw warmth from the occupants. This is most harmful when a person 
is sleeping, as the temperature of the body is then lowered; and it must be 
earnestly advised not to place beds close to damp walls. Catarrh and 
rheumatism are frequent results of living in damp houses, in which the air 
is generally poor on account of the rotting and moldering processes con¬ 
stantly going on. In consequence, wooden furniture warps, dresses get 
moldy, and articles of food decompose. The fungi which sometimes appear 
in damp houses add malodorous elements to the atmosphere, but do not 
contribute to the causes of disease. There is much hygienic buncombe, 
however, regarding dampness in dwellings, dampness often not being dis¬ 
tinguished from lowered temperature. 

If there have been dangerous contagious diseases in a house, the patient’s 
room should be disinfected after the disease has run its course, so that the 
disease-germs will not remain and cause new infections. When moving 
into a new house it is important to ascertain whether the former occupants 
were healthy. If there were contagious diseases (consumption, for in¬ 
stance) the house should not be occupied before it has been thoroughly 
disinfected. It is best also to inquire about the possibility of contagious 
diseases among the neighbors, and if necessary to keep isolated from them; 
special attention should be given to the children, that they do not associate 
with children living in infected houses. See also the articles Bed; Disin¬ 
fection; and Light. 

DYESTUFFS, POISONOUS.— Although the employment of dyestuffs, 
especially of those inimical to health, is regulated by law, cases of poisoning 
caused by them continue to occur. The poisonous dyestuffs most frequently 
used contain arsenic (green dyes), lead (white and black lead; Naples yel¬ 
low), chrome (red and yellow), gamboge (yellow), and picric acid (in yellow 
dyes). Anilin dyes often contain arsenic. Poisonous dyestuffs are most 
frequently found in articles in common use; for instance, in diess-goods, 
furniture coverings, wall-paper, artificial flowers, candles, toys, and picture- 
books; rarely in cheap candy. Only the three last objects may give rise 
to acute poisoning which must at once be treated by antidotes (see Arsenic- 





Dysentery 

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THE STANDARD FAMILY PHYSICIAN 


288 


Poisoning; Lead-Poisoning). Dress-goods, wall-paper, and other articles 
containing poisonous dyes may cause chronic poisoning by inhalation of 
the dust or vapors arising in their manufacture. Such cases of poisoning 
usually manifest themselves by nausea, vomiting, diarrhea, and severe head¬ 
aches; or by external symptoms, such as skin-diseases, or inflammation of 
the eyes. See Occupation Diseases. 

DYSENTERY. —An acute or chronic infectious disease, the seat of which 
is in the large intestine. It occurs in all climates, but most frequently and 
most severely in warm countries. In the temperate latitudes it occurs 
chiefly in summer and at the beginning of autumn; sometimes, especially 
in times of war, it occurs in the form of epidemics. The infectious principle 
is contained in the discharges from the bowels of the patients. Infection 
in most cases is brought about by the drinking of water which is contami¬ 
nated by excremental substances. Owing to the general improvements 
made with regard to the water-supplies, the frequency of the disease has 
greatly diminished during the last decades. Among the causes which 
directly give rise to the outbreak of dysentery are colds, and errors in diet, 
especially the eating of decayed food, unripe fruit, or of food not readily 
digestible. To these must be added certain bacteria. Three forms of the dis¬ 
ease are to be distinguished: Catarrhal, gangrenous, and chronic dysentery. 

Catarrhal dysentery begins generally as a simple diarrhea. After one or 
several days, abdominal pains, located especially in the region of the navel, 
and painful but unsuccessful efforts to evacuate the bowels ( tenesmus) 
occur. The stools assume the appearance which is characteristic of the 
disease, consisting either of small quantities (rarely more than a table¬ 
spoonful) of glassy mucus with bloody streaks, or of blood-colored mucus. 
The discharges from the bowels become more and more frequent, and the 
abdominal pains as well as the tenesmus also increase in severity. The 
number of movements within twenty-four hours may be 20, 30, or more. 
If the disease progresses, the condition of the stools usually changes after 
several days. They consist then of a yellowish or reddish fluid upon which 
float yellow, reddish or red particles which resemble chopped meat and are 
composed of blood and mucus. The appetite is lost. The strength of 
the patient diminishes considerably and rapidly. The disease, if treated 
correctly, lasts rarely more than a week. In some instances, however, it 
may be protracted for several weeks. 

Gangrenous dysentery may begin as the catarrhal form, but in this 
affection the stools are changed into a brownish-red or blackish, smeary 
fluid of putrid odor, which contains smaller or larger gangrenous portions 
of the intestinal wall. The movements of the bowels are extremely fre¬ 
quent, 100 times and more in twenty-four hours, so that the patients are 
actually unable to leave the commode. Great weakness is present at the 
same time. Death is usually due to exhaustion. 





289 


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Dysentery 

Ear 


Chronic dysentery is principally a disease of the tropics, and generally 
develops from the catarrhal form. After actual or apparent recovery from 
the latter affection, repeated relapses occur which finally develop into chronic 
dysentery. In other cases it commences at once as a chronic affection, 
with occasionally occurring diarrheas. The discharges from the bowels, 
usually five to six daily, are thin, often watery, and contain admixtures 
of mucus, blood, and pus. They are often distinguished by an offensive 
odor. Pains and tenesmus are only slight or are entirely absent. Some¬ 
times diarrhea alternates with constipation. The stools may even for a short 
time assume a normal condition. If not treated, the disease may eventually 
be protracted for months and years, while the patients continue to emaciate 
and become anemic until, finally, they die from general exhaustion. 

Treatment of dysentery until the arrival of the physician, who must be 
called as soon as possible in every case, consists in rest in bed, and in the 
application to the abdomen of linseed-poultices or poultices which become 
warm (see Poultices); hot-water bags or thermophores will also render 
good services. The diet should consist of fluid nourishment only; best 
of boiled warm milk, or of gruel and flour soups. In order to prevent the 
spread of the disease, it is important that the stools of the patients and 
everything soiled by them, such as linen, toilets, night-stools, etc., should be 
thoroughly disinfected. See Disinfection. 

DYSPEPSIA. —See Stomach, Diseases of. 


EAR.— For structure and functions see Introductory Chapters (pp. 
70-72). 

EAR, CARE OF. —The care and protection of the ear should begin with 
the nursling. In the infant the tympanic cavity, which later is filled with 
air, is at first full of mucus which may suppurate if the mouth or ear is 
unclean. Hence, cold should be avoided as it reduces the resistance of 
the infant and permits or aids infection. Water should not be permitted 
to enter the ears or the nose. A coryza, or cold in the head, may cause the 
Eustachian tube to become closed by swelling of the mucous membrane, 
and thus prevent the entrance of air into the middle ear. Phis disturbance 
may eventually be followed by deafness. After the bath it is necessary 
carefully to dry the folds behind the ears, as otherwise moist and obstinate 
eruptions of the skin may arise. Loud sounds should be avoided. A 
child that is addressed in a loud manner often cries because the noise causes 

pain in the ear. 

A hood to press the lobes of the ear to the head is not only supei fluous and 
without benefit, but possibly harmful. A bandage for this purpose is shown 
in Fig. 117. The best protection against diseases of the ear is afforded 





Ear 


THE STANDARD FAMILY PHYSICIAN 


290 



by hardening the entire body (see Hardening), which should begin as 
early as possible. 

A healthy ear requires neither ear-muffs nor cotton-pledgets as a special 
protection against wind or cold; although it should be guarded against 
freezing during sleigh rides, hunting trips, etc. Neither does the healthy 

organ require any special care. If 
plenty of ear-wax be present, a 
daily cleansing with a soft, dry cor¬ 
ner of a towel is sufficient. Even 
this cleansing should be omitted in 
small children. Ear-picks, hair¬ 
pins, and ear-brushes are unclean 
and unnecessary, sometimes even 
dangerous. They do not prevent, 
but cause, the accumulation of ear- 
wax, as well as affections of the 
auditory canal. To place pieces 
of cotton, onion, garlic, bacon, 
camphor, etc., into the ear in case 
of toothache is without benefit, 
and nonsensical. 

Piercing the ears for earrings is 
a barbarous custom, occasionally 

Fig. 117 . Bandage f °r Pressing the ear-lobes against leading to inflammation and even 

to tuberculous degeneration of the 
lobe of the ear. The wearing of earrings as a protection against disease, is a 
foolish superstition still prevailing, especially in foreign countries. Frequent 
picking and scratching of the ear causes inflammation of the auditory canal; 
unnecessary irrigation of the ear with oil prepares the soil for obstinate ac¬ 
cumulations of fungi leading to inflammations, earache, and disturbances 
of hearing. Nasal douches are fraught with danger to the ear; even the 
drawing of cold water into the nose may be harmful. 

The ears are subject to new dangers when the children go to school. 
Pulling the ears is apt to cause contusions and inflammations of the car¬ 
tilages, sometimes leaving permanent deformities of the lobe of the ear. 
Blows may lead to tears and to exudations of blood. By vigorous boxing 
of the ears the drumhead may be ruptured; even the labyrinth may be in¬ 
jured, and permanent deafness be the result. In cases of recent rupture 
of the drumhead, the layman should never attempt to pour anything into 
the ear, as incurable impairment of hearing is frequently the result of such 
an unsuitable procedure. In school, difficulty of hearing is often misjudged 
as stupidity, and unnecessarily punished. It is the duty of school phy¬ 
sicians, therefore, to examine all children for defective hearing. 










291 


THE STANDARD FAMILY PHYSICIAN 


Ear 


When diving head foremost during bathing, the drumhead is very apt 
to rupture. Likewise, when bathing in the ocean, a wave that is caught 
from the side instead of backward may injure the ear. 

Loud sounds injure the faculty of hearing, particularly when occurring 
unexpectedly. Artillerymen and boilermakers, for instance, are extremely 
liable to deafness. Explosions and gunshots in closed rooms are also 
dangerous. Engine drivers who suffer from the shrill whistling of the loco¬ 
motives and from long-continued standing upon the vibrating engine, 
are very liable to become deaf. To deaden the sound, small, light balls of 
cotton are used, which can be placed into the ear when necessary. 

The public should be interested in this matter of hygiene of the ear, and 
should take steps to prevent unnecessary noises. A great deal might be 
accomplished by the prohibition of whip-cracking, the playing of hand- 
organs, and the burning of noisy fireworks, by the improvement of pave¬ 
ments, the regulation of noisy work, and by the division of towns and cities 
into factory districts and residence districts, etc. 

Heredity exerts an influence upon affections of the ears, especially upon 
chronic, dry inflammation of the middle ear. The consultation of a phy¬ 
sician before marrying is, therefore, advisable in certain cases. Marriages 
of near relations sometimes favor congenital deafness. 

EAR, DISEASES OF. —Diseased conditions of the auditory apparatus 
may involve either the external parts of the ear (the concha ), the external 
auditory canal, or the internal ear. Middle-ear inflammations (which see) 
usually proceed by way of the Eustachian canal, from the throat outward 
to the middle ear. 

i. Diseases of the External Ear are usually due to injuries sustained as 
by blows or accidents which may lead to the formation of blood-tumors, to 
obstruction of the external auditory canal, or even to suppurative inflamma¬ 
tion. The last-named condition may arise also from transmission of sup¬ 
puration from an inflammation of the middle ear. 

Blood-Tumors are generally caused by violent blows upon the ear, which 
result in exudations of blood under the cartilage and skin, so that some 
parts of the ear swell. Such blood-tumors were of rather frequent occur¬ 
rence in Roman and Greek gladiators, and are still found in wrestlers, 
prize-fighters, etc. Inmates of insane asylums occasionally suffer from 
this condition, which may be due either to their own violence or to rough 
handling by attendants. These blood-tumors usually disfigure the ear 

considerably. 

Foreign Bodies are sometimes found in the external ear, those most 
frequently encountered being beads, shoe-buttons, beans, peas, seeds, 
paper balls, pieces of wax, and forgotten pledgets of cotton or onion. Flies, 
roaches, bedbugs, and fleas are rarely found in the eai; the so-called car- 
worm” never. The removal of foreign bodies from the ear never requires 






Ear 


THE STANDARD FAMILY PHYSICIAN 


292 


great haste, and it is always possible to avoid such injuries of the organ 
as are frequently caused by the assistance of unprofessional persons hur¬ 
riedly summoned. Living animals are destroyed by injections of glycerin 
or alcohol. This being accomplished, the aid of an ear specialist may be 
called at leisure. Unskilled assistance may cause severe injuries which may 
eventually lead to loss of hearing, or even to death.- 

Until the ear has been examined by a physician with the aid of an ear 
speculum, it may in many cases remain doubtful whether the supposed 
foreign body is in the external auditory canal at all; and not a few dangerous 
operations have been performed by untrained persons to remove a foreign 
body which was not present. On the other hand, a dead object which does 
not swell may often remain in the auditory canal for years, even for decades, 
without endangering the ear. 

Acute Inflammation of the auditory canal may be due to the transmission 
of middle-ear suppuration, to mechanical injuries caused by scratches, 
foreign bodies, etc., or to burns resulting from the injection into the ear 
of hot substances. Most frequently, however, the inflammation is due to 
the formation of furuncles or pimples in the external ear. The furuncle 
begins in the membrane of the auditory canal as a small, red point, and is 
very painful to the touch. It is usually situated near the external opening 
of the ear, and may either recede of itself or go on to suppuration. The 
pain and swelling generally diminish after the discharge of a small quantity 
of bloody pus. 

Furuncles rarely occur singly, and after their first appearance they are 
apt to recur at intervals, so that the symptoms of the disease may come 
and go for weeks, causing restless nights, and impaired nutrition in conse¬ 
quence of the pain experienced on chewing. Many persons are especially 
predisposed to furuncles. 

Scratching and habitual picking of the ear should be avoided, as it often 
gives rise to the formation of furuncles. These are also frequently trans¬ 
mitted from one ear to another by means of contaminated ear-picks and 
similar objects. When occurring in large numbers, furuncles may cause 
considerable swelling which closes the auditory canal and impairs hearing; 
but the patients always recover. The pain which results from inflammation 
of the auditory canal may be alleviated by the application of hot poultices 
or by alcohol compresses. 

Chronic Inflammation of the skin of the auditory canal is usually pain¬ 
less, leading merely to the discharge of an increased quantity of ear-wax. 
In the auditory canal this combines with the cast-off particles of skin to 
such an extent that it can be removed only with difficulty and only by a 
physician. Small scales and dry particles are discharged from the ear at 
brief intervals. Itching is the most conspicuous disturbance. Irrigations 
of the ear should be avoided as they may aggravate the condition. 



293 


THE STANDARD FAMILY PHYSICIAN Ear 


2. Diseases of the Internal Ear affect that part of the organ which is 
situated internal to the drum-membrane. The most common of these is 

inflammation of the middle ear, which may occur as a catarrh with mucous 
accumulations in the tympanic 


cavity, or as a suppuration with a 
purulent condition of the inflam¬ 
matory exudations. These forms 
differ from each other largely in 
the degree of intensity, taking into 
consideration also the factor of in¬ 
fection. 

Acute Catarrh of the Middle 

Ear usually begins with sudden, 
piercing pain in the ear, with ring¬ 
ing and beating, and with a sensa¬ 
tion of obstruction. If the function 
of hearing is not impaired, only an 
inflammation of the tympanic mem¬ 



Fig. 118. Ear-bandage. 


brane (the drumhead) may be present; if the acuity of hearing dimin¬ 
ishes, the middle ear is usually involved also. A rise of temperature 
is often present, and may be very marked in children, leading to spasms, 
and frequently disturbing the general health to such an extent that con¬ 
fusion with other affections may occur. All the disturbances increase in 
intensity during the night; and the act of chewing is often a very painful 
process. 

If perforation of the drumhead takes place, the pains usually cease, but 
not the fever. A sense of fulness and pressure, difficulty of hearing, and ring¬ 
ing of the ears may persist. Sometimes perforation occurs during the first 

twenty-four hours of the disease, causing a flow of bloody 
mucus; at other times it may take several days, and inci¬ 
sion into the drumhead must often be resorted to in order 
to relieve the patient of his pain. In cases of simple catarrh 
of the middle ear, the drumhead usually heals in a few 
days, provided infection does not take place. 

Injections of oil into the ear, so widely used, tend to in¬ 
troduce bacteria into the organ, thus adding the factor of 
infection. Patients should be confined to bed, and small 
cotton pledgets soaked with antiseptic solutions should be 
used to cleanse the external ear, while great care should 
also be taken to keep the mouth and nose as clean as pos¬ 
sible. Hot-water bottles are often very grateful to the pa¬ 
tient, as they diminish the pain of an earache. Breathing hot smoke into 
the ear is sometimes of service, but if the little patients are unable to sleep 



Fig. i 19. Ear-syringe 












Ear 


THE STANDARD FAMILY PHYSICIAN 


294 


by reason of the pain, the inflammation is usually acute enough to demand 
operative treatment of the ear-drum. 

Purulent Inflammation of the Middle Ear (“running of the ear”) begins 
as a simple catarrhal process, but the disease is more acute and the symp¬ 
toms more marked. Beating sounds like the strokes of a hammer occur, 
and the entire side of the head becomes painful. Chewing is often very 
difficult, and even the concussion caused by walking intensifies the pains 
which are scarcely endurable, especially at night. The general symptoms 
in children are sometimes so severe as to resemble a meningeal inflammation. 



Fig. 120. Mode of washing out ear with syringe. 


Violent chills are frequent. Perforation of the drumhead takes place under 
turbulent manifestations, and the purulent discharge is often so profuse 
that the pillow or bandage may be soaked by it. In cases of severe sup¬ 
puration it may happen that large portions of the drumhead, and even 
the ossicles are lost. Such severe cases are met with at times in measles and 
scarlatina, and may result in complete deafness. Sometimes the external 
auditory canal becomes inflamed also, or the affection may spread to the 
mastoid process. See Mastoid, Diseases of. 

The disease may terminate in (i) recovery without permanent changes; 
(2) in scars or permanent perforation of the drumhead; (3) in loss of the 
ossicles of the middle ear or contracted scar formation of the middle ear 
with permanent difficulty of hearing; (4) in transition into chronic sup¬ 
puration; or (5) in death from involvement of the brain. The occurrence 
of purulent suppuration of the middle ear may be favored by frequent 









295 


THE STANDARD FAMILY PHYSICIAN 


Ear 


attacks of nasopharyngeal catarrh, and by enlargement of the tonsils, 
especially of the nasopharyngeal tonsil. The most serious cases of the 
affection are encountered as complications of scarlatina. 

Examination and treatment by a specialist is imperative, and the belief 
that “running of the ears” is of little significance, or is even conducive to 
health, is thoroughly obsolete and pernicious. Running of the ear is a 
serious matter, and the advice of a layman is not reliable. The pain 
may be allayed by hot compresses, fomentations, linseed poultices, etc. 
Cold air and cool baths must be avoided. The extension of the process 
to the mastoid cells or to the meninges is accompanied by high fever, by 
headache, by soreness behind the ear, and by other localizing signs. These 
cases need operation, and usually without delay. Chronic suppurative disease 
of the middle ear is not common. It requires operative treatment as a rule. 

EAR, ITCHING OF. —A sensation due to a persistent eruption in the 
auditory canal, which sometimes is accompanied by the secretion of mois¬ 
ture, at other times by the casting off of dry scales. The affection is diffi¬ 
cult to cure, irrigations tending only to aggravate the condition. Scratching 
and picking of the ear are most apt to lead to furuncles of the auditory 
canal. See Diseases oj the External Ear , s. v. Ear, Diseases of. 

EAR, POLYPI OF. —Peduncled tumors which arise as a result of per¬ 
sistent suppurations of the ear, mostly when the bones are affected by the 
pus. They should be looked upon as tissue proliferations. By obstructing 
the auditory canal they cause a retention of the pus, which may lead to 
dangerous consequences. Sometimes these polypi become so large that 
they project from the ear as bleeding pieces of flesh. They are easily removed 
with a snare or with a sharp spoon. 

EAR, RINGING OF.— A frequent symptom which may be due to various 
causes. When due to Ear-Wax Plugs (which see) it is readily curable. 
Often it is a symptom of deep-seated affections of the ear, such as chronic 
catarrh of the middle ear; in other instances it is of nervous origin. In 
some cases the sounds are sizzling, buzzing, or hissing; in others they re¬ 
semble ringing, chirping, or whistling. Ringing in the ears may at times 
give rise to aberrations of judgment (hallucinations); but the symptom 
which consists in perceiving sounds that nobody else can hear is not a sign 
of an affection of the ear, but of a mental disease. If the ringing is incessant, 
the results of treatment are less hopeful than when it occuis only occasion¬ 
ally. Before deciding upon any plan of treatment it is necessary to deter¬ 
mine the cause of the ringing. It often happens that patients become 
accustomed to the buzzing sounds, and cease to notice them. Sometimes, 
however, the affliction is so marked that hearing is greatly impaired; and 
it may cause mental depression, and even suicidal intentions. External 
noises, such as the bustle of the street, music, etc., deaden the sensation, 
whereas the quiet of the night intensifies it. 






Ear-trumpet 

Egg 


THE STANDARD FAMILY PHYSICIAN 


296 


Brief, occasionally high-pitched, ringing of the ear, which is heard like 
the fine ringing of glasses, is a normal phenomenon. If it persists for 
some time, or if it recurs regularly, there is scarcely any possibility of curing 
the condition. Muscular spasms of the internal ear occasionally cause a 
brief, flapping or crackling noise which is without significance. The mus¬ 
cular noises are at times so loud that they may be heard, not only by the 
patient, but even by other persons at some distance. The most common 
cause of mild buzzing in the ear is chronic catarrhal inflammation of the 
middle ear. This affection frequently leads to deafness. 

EAR-TRUMPET. —See Hearing, Deficiency of. 

EAR-WAX PLUGS. —Yellowish to brownish accumulations of fat ex¬ 
creted from the glands in the skin of the auditory canal. Sometimes these 
plugs are so large and so hard that they represent an actual cast of the audi¬ 
tory canal. They are removed by first softening them with oil or soap- 
water, and then irrigating the ear. The symptoms of the condition are 
ringing, itching, and difficulty of hearing; in very rare cases it may give 
rise to nervous cough, and to spasms. 

ECLAMPSIA, INFANTILE. —A nervous affection of infants, charac¬ 
terized by convulsions. This symptom, which may appear in milder or 
severer forms, is never a disease of itself, but is always a result of other 
affections. The most common causes are: beginning measles, diphtheria, 
scarlatina, meningitis, catarrh of the stomach or intestine, cholera morbus 
(most important), constipation, inflammation of the lungs, purulent in¬ 
flammation of the ears, and intestinal worms. The milk of an intoxicated 
wet-nurse has been known to give rise to convulsions resembling eclampsia. 
It is highly doubtful if mental excitement or anger on the part of the wet- 
nurse may be regarded as possible causes of the condition. In the majority 
of cases the symptom occurs in children afflicted with Rickets (which see), 
especially when the bones of the skull are involved. It is incorrect to as¬ 
cribe the appearance of convulsions to teething. 

In the milder forms, which occur usually in children less than a year 
old, the children sleep with the eyelids half open, showing the eyeball 
turned upward. Slight twitchings of the muscles of the face occur, creating 
the impression that the child is smiling. It sometimes happens that the 
limbs convulse slightly; that the hands are clenched with the thumbs under 
the fingers; and that breathing is irregular, alternately deep and super¬ 
ficial, slow and quick. This condition is popularly known as “silent 
spasms.” 

The severer form, which often closely resembles an epileptic convulsion, 
comes on suddenly as a rule. Sometimes, however, it occurs in connection 
with the “silent spasms” previously described, quite independent of whether 
the child is asleep or awake. Infants become unconscious and cry aloud; 
older children grind the teeth, stare, squint or roll the eyes, toss the head 





297 


THE STANDARD FAMILY PHYSICIAN 


Ear-trumpet 

Egg- 


back, and throw the body backward. The limbs are alternately drawn in 
and thrust out, or are held spasmodically rigid or twisted. The lower jaw 
is sometimes opened and closed with a snap; respiration is suspended; 
the face turns blue; foam appears at the mouth; and gas, excrements, or 
urine may be passed involuntarily. Sometimes death occurs during the 
attack. The duration of the convulsions varies; they usually last only for 
a few seconds, but often for several minutes. Eclampsia may come on in 
single attacks, or it may recur. After the attack the child is weak, listless, 
and generally sleeps for hours. 

During the attack it is necessary that all bands and constricting dresses 
be loosened, and that respiration be stimulated by dashing cold water on 
the face or chest of the patient. The thumbs may be left clenched under 
the fingers, but the child should be guarded against injuries. Until the 
arrival of the physician, who should be summoned at once, attempts may 
be made to arrest the spasms by a warm bath (95 0 to 104° F.), or by an enema 
consisting of \ pint of vinegar and J pint of hot water. Hot foot-baths 
are sometimes of service. 

ECLECTICISM. — See Medicine, History of. 

ECZEMA. —See Skin, Diseases of. 

EGG. —An article of diet which consists of the germ and food-yolk ex¬ 
truded from the ovary of a bird, usually of the domestic hen, and which is 
enclosed in a calcareous shell. It is a common practise to stir up the yolk 
of an egg with the soup intended for a sick person, while the white is re¬ 
served for other purposes. This is a great mistake, for although the nu¬ 
tritive value of the yolk is considerable, this depends largely on the fat 
present; while the amount of albumin contained in the yolk, compared 
with that in the white, is in the proportion of 15 to 25. The white, how¬ 
ever, does not consist solely of albumin, this being present only to the ex¬ 
tent of 13 per cent., while water constitutes another 85.9 per cent. On an 
average, 50 grams of eggs is the food equivalent of about 40 grams of meat 
and not quite J of a quart of milk, so that a pound of meat is cheaper than 
a like quantity of eggs, leaving aside the fact that the salts contained in 
meat largely increase its food value. The value of eggs as food must neither 
be overrated nor underrated. Their wide employment is extremely essential, 
for they may be incorporated with numerous dishes, not only increasing 
their food value but also their palatability. 

It is important to know that fresh eggs are moderately transparent and 
that this transparency disappears as their age increases. Moreover, if 
placed in a 5 to 10 per cent, solution of salt, old eggs sink to the bottom of 
the vessel. These tests are well enough for the gormand, but the practical 
housewife will find the same nutritive values in eggs which have been pre¬ 
served by artificial means, provided no decay has taken place; and the 
variations in transparency and weight which accompany increasing age are 






Elaterinum 

Electricity 


THE STANDARD FAMILY PHYSICIAN 


298 


merely due to the loss of water through the more or less pervious shell. In 
all cases where it is intended to add strength and nourishment to a dish the 
entire egg should be used, and not the yolk only. Stirring an egg in soup is 
the most effective way of giving this food; while the most unsatisfactory 
is to allow the patient to drink a raw egg, for in this instance the albumin 
is coagulated in the stomach in lumps, of which only the outer surface is 
attacked by the gastric juice, while the interior may remain undigested and 
be wasted. Boiled eggs are therefore to be preferred to raw eggs, and 
those in which the white is coagulated and the yolk still somewhat fluid 
are easiest to digest. But even the hard-boiled egg will not “lie like a stone 
in the stomach” if the precaution be taken to masticate it thoroughly. Lack 
of attention to this point will impair the digestibility even of the soft-boiled 
egg, the point being to prevent the albumin from reaching the stomach in 
large masses. A hard-boiled egg may be digested readily and without 
difficulty by even a weak stomach, and the nourishment thoroughly used 
up by the body. 

ELATERINUM. —A neutral principle obtained from the juice of the 
fruit of a cucumber-like plant, Ecballium elaterium (“Squirting Cucum¬ 
ber”), a native of the Mediterranean regions of Europe and Asia. The 
principle is an active cathartic, causing large, watery stools even in doses 
of To" g ra i n - The passages are usually unaccompanied with much pain, 
and on this account the drug is generally used in combination with other 
cathartics. It has been used in times past to relieve local effusions of 
dropsical fluid. 

ELECTRICAL ACCIDENTS. —The maximum tension of an electric cur¬ 
rent which a human being can endure is about 500 volts. The alternating 
current as a general thing is more dangerous than the direct current, and 
fatalities have been reported where the individuals grasped two conductors 
in which the tension of the alternating current only slightly exceeded 100 
volts. Alternating currents produce a muscular spasm, so that it becomes 
difficult to release the conductors, whereas the powerful blow of the direct 
current throws the person away. 

Strong electric currents momentarily inhibit respiration and make the 
heart beat slower; if the breathing is suspended for any length of time, the 
heart also stops. The victim of a severe electric shock is usually rendered 
unconscious. This condition may last for several hours and may then be 
succeeded by a feeling of exhaustion, vertigo, headache, and an irritable 
and irregular pulse. Where the current enters the body it may cause swell¬ 
ings, burns, or bleeding into the subcutaneous tissue; or there may be 
foimed the curious blanching strise shown in Fig. 121, and the skin may 
be perforated. These blanched markings are commonly seen following 

lightning burns. They have nothing to do with standing under trees, or 
the like. 



299 


THE STANDARD FAMILY PHYSICIAN 


Elaterinum 

Electricity 



121. Markings on the body of a 
person killed by a stroke of lightning. 


In extending assistance to a person who has been shocked, it is well 
for the rescuer to exercise certain precautions in order that he himself may 
not be affected by the current. The wire or other conductor may be re¬ 
moved with a dry stick or other non-conduct¬ 
ing material. If this is not possible, the res¬ 
cuer should insulate himself by standing on 
some non-conducting substance, by putting 
on rubber-gloves, or by wrapping the hands 
in some dry articles of thick clothing before 
pulling the injured individual away from the 
source of the electricity. The current may 
also be drawn off into the earth by throwing 
a metal chain or similar object over the live 
wire. If the injured person hangs suspended 
from a wire, care must be taken that he is not 
hurt by falling. Where the body can not be 
extricated from the tangle of wires, it may be 
lifted in order to interrupt the current; or the fig 
victim may be insulated by the placing of 
clothes, boards, or other non-conducting articles under those parts which 
come in contact with the earth. 

If the injured person is unconscious he should be undressed, a folded 
coat placed under his shoulders, the tongue drawn forward, and attempts 
made to bring on voluntary respirations by tickling the nose and pharynx. 
If this is unsuccessful, Artificial Respiration must be resorted to, and 
the heart stimulated by administering hot tea or coffee. 

ELECTRICITY, THERAPEUTIC APPLICATIONS OF.— Electrotherapy 
was first used in the eighteenth century, although scientific investigations 
regarding the nature and effects of the electric current in its applications 
to the human body were not instituted until the nineteenth century. Not¬ 
withstanding the numerous and laborious experiments and observations, 
very little is known of the manner of its action. But one thing is certain in 
spite of the many doubters, and that is that many patients are improved 
and their illness shortened by the applications of this agent. Its value in 
motor and sensory paralyses is undoubted, and the quieting and analgesic 
influences attendant upon its use form one of the main indications for its 
employment. 

The principal forms in which electricity is ordinarily applied are (i) by 
the continuous or galvanic current; (2) by the interrupted or faradic cur¬ 
rent; or (3) by the Franklin current. In recent years a number of addi¬ 
tional varieties of currents have been devised, but these demand the test 
of time before they can be more generally employed. In order that the 
use of the electric current may be efficacious and successful, it is necessary 











Elf-Lock 

Emaciation 


THE STANDARD FAMILY PHYSICIAN 


300 


to determine the proper strength needed, and the time of application. This, 
however, is such a difficult matter, and requires so much experience that 
only a physician should employ this agent in the treatment of disease. Lay¬ 
men are very apt to use electricity without the exercise of any judgment or 
reason, basing its use on the maxim “the stronger, the better.” A warning 
note should be sounded against this misuse of a very powerful therapeutic 
measure. Very often a weak, almost insensible, current may be of greater 
value and efficiency than one which is so strong that it can scarcely be 
endured by the patient. 

As applied by the laity, the current can only do harm; and the lack of 
tangible results usually serves to condemn this measure in the popular esti¬ 
mation. Neither may the “electrification” as made use of in exhibitions 
and country fairs be compared to its employment by the medical practitioner, 
as the antics produced in the victim are merely of value in amusing the 
surrounding spectators. One who desires to be benefited should therefore 
consult a physician, and not entertain any fears about any possible hurt or 
injury. In many cases currents that are weak and easily endured are 
sufficient. If stronger varieties are required, the patient may be accus¬ 
tomed to their effects by the aid of special appliances attached to the electric 
apparatus, by means of which a slow and scarcely noticeable increase of the 
current is rendered possible. The patient may thus be made to endure a 
current of considerable strength, which would be productive of great dis¬ 
tress if it entered the body suddenly. It is only in a small number of con¬ 
ditions, however, that the stronger forms of current are necessary. 

Electricity is employed also in the electric water-bath, electric light-bath, 
and for heating certain instruments (such as needles, snares, and cauteries) 
which are used for the purpose of removing unsightly moles and hairs, or 
for excising polypi or thickenings in the nose. In addition to its curative 
properties, electricity is used also in examinations, for testing the irritability 
of nerves and muscles, and for illuminating internal organs, etc. For the 
value of X-rays in diagnosing disease, see Diagnosis and Treatment 
of Disease (p. 94). 

ELF-LOCK (PLICA POLONICA). —A closely knotted or entangled mass 
of hair, matted together by the sticky discharge of ulcers, moist sores, or 
open wounds of the head. Lice may or may not be present in connection 
with this condition, which is usually due to uncleanliness and neglect. 
This uncleanly disease, which is particularly indigenous to Posen, Poland, 
and Russia, can be treated only by cutting off the elf-lock, a procedure 
which is absolutely without danger. 

ELEPHANTIASIS. —A condition which commonly affects the legs, and 
which consists of a chronic, uniform swelling, usually of the portion below 
the knee, and including or omitting the foot in its effects. In rare cases it 
may involve also the thigh (see Fig. 122). The disease may be caused by 




301 


THE STANDARD FAMILY PHYSICIAN 


Elf-Lock 

Emaciation 


repeated inflammations of the skin, lymphatics, or blood-vessels, or by 
chronic moist eczemas. That form of the disease more commonly found 
in the tropics than in temperate climates, and which constitutes the true 
elephantiasis, is due to a parasite which 
is present in the blood of the affected in¬ 
dividual. Some relief may be afforded by 
elevation of the limb, by enveloping the 
same in bandages of flannel or rubber, by 
various applications, and by massage. 

Although ordinarily harmless, the con¬ 
dition is extremely annoying, and where 
the weight of the leg becomes unbearable, 
it may be necessary to resort to surgical 
measures. See Filaria. 

EMACIATION. —Excessive loss of flesh. 

The main indication of good health is a 
uniform body-weight; that is to say, the 
weight of the healthy, normally developed 
body should show neither marked gains 
nor marked losses. A loss should always 
be looked upon with suspicion, and faulty 
nutrition must be regarded as the cause. 

This is the case when the amount of 
nourishment absorbed is insufficient, either Fig. 122. Elephantiasis in the lower 

ex tremities 

because the quantity of food taken does 

not suffice for the needs of the body, or because the composition of the 
diet is such that the nutrient materials required to sustain strength 
are not incorporated. On the other hand, certain abnormal conditions of 
the body (such as diabetes) may be present which interfere with proper 
assimilation; or the powers of absorption may have been diminished below 
the requisite limits. This latter condition is present in almost all diseases, 
but it is most marked in those involving the alimentary tract. Not only 
does the disease itself cause more or less disturbance in the body economy, 
but the accompanying loss of appetite adds to the danger. The enforced 
rest to which a sick person is subjected reduces, of course, the demands upon 
his strength, but a certain amount of expenditure always takes place as long 
as the heart acts and breathing continues. In addition to these causes, must 
be considered the wasting effects of fever and the loss of bodily strength 
brought about by suppurative processes. It is a fortunate circumstance, that 
the demands which disease occasionally makes on the body are compen¬ 
sated for by the stores of fat and muscular substance which generally have 
been accumulated during periods of health. The loss of these affords the 
outward manifestations of emaciation. In this manner the internal organs 

























Embolism 

Enema 


THE STANDARD FAMILY PHYSICIAN 


302 


are not called upon to contribute to the demands made by the illness in 
order to sustain life; and their vital functions are not made to suffer. 

EMBOLISM.— Term designating the occlusion of a blood-vessel by some 
matter which has been carried along by the blood-stream. The obstruction 
{embolus) may consist of a clot of blood, of a small mass of disintegrated 
tissue thrown off by an inflammatory process, or of fat which has entered 
the vessel in consequence of injury. When such an embolus occludes one 
of the great arteries of the heart, sudden death will ensue. If the occlu¬ 
sion be only partial, it usually results in more or less severe disturbances 
of nutrition in some parts of the body, giving rise to inflammation or gan¬ 
grene. Partial occlusion of the pulmonary artery, for instance, may result 
in gangrene of the lungs. Embolism of a cerebral artery is one of the 
causes of apoplexy (see Brain, Apoplexy of). The entrance of air- 
bubbles into the blood-stream likewise causes occlusion of the vessel, and 
frequently results in sudden death. 

EMETICS. —See Domestic Remedies; Vomiting. 

EMPHYSEMA. —See Lungs, Diseases of. 

EMPIRICISM. —See Medicine, History of. 

EMPYEMA. —See Pleurisy. 

ENEMA. —A fluid injection passed into the rectum. According to the 
purpose which it is desired to accomplish, distinction is made between three 
forms of enemas: (i) those introduced in order to cleanse the bowel, as 
in constipation, or to remove irritants in diarrhea; (2) those used to supply 
water to the body or to influence the kidney secretions; and (3) those in¬ 
troduced for the purpose of nourishing the body (nutrient enemas). 

Cleansing enemas serve to remove constipated or hardened masses of 
feces. They are of great service also in non-constipated patients, in whom 
it seems necessary to empty the large intestine. Fluids answering the pur¬ 
pose are: water of varying temperature (even icy cold); water with the 
addition of soap, salt, or vinegar; oils of various kinds; glycerin, etc. The 
quantity of water used for an enema varies from one pint to two quarts. 
Glycerin is injected with a special syringe (see Fig. 123) in doses of from 
two to five grams. Oil may be introduced in the same manner, the usual 
dose being a few tablespoonfuls. Larger quantities should be used only 
in certain modes of treatment for persistent constipation. The injection 
is made by means of an irrigator of glass, tin, or rubber, which should 
preferably be supplied with an olive-shaped (but always rounded) nozle (see 
Fig. 124). Special enema syringes, the smaller ones of which hold from 
two to thirty grams, and the larger ones a pint or more (see Fig. 125), are 
especially useful when oil or glycerin is administered. Water may be in¬ 
jected into the rectum also from a glass funnel supplied with a rubber- 
hose. The fountain-syringe so widely used in the United States is the best 
medium for giving an enema. The injection should always be made very 







303 


THE STANDARD FAMILY PHYSICIAN 


Embolism 

Enema 


slowly and with but slight pressure. The bag, therefore, should not be 
held at too high an elevation. Injuries to the rectum by the nozle of the 
syringe 01 of the irrigator can always be avoided by careful handling. 



Fig. 123. Glycerin 
syringe. 




Fig. 124. Irrigator. 


Fig. 125. Hard- 
rubber syringe. 


For small children one-half to one pint of water is sufficient. To chil¬ 
dren of a few years of age, and to nurslings, enemas may be given by the 
fountain-syringe or by means of a small rubber-ball with a cone-shaped nozle 
(see Fig. 127). The fluid drawn into the ball is squirted into the rectum 
with slight pressure. The patient should be placed properly for the ap¬ 
plication of an enema, best upon 
one side of the body, or with raised 
buttocks; the anus must be easily 
accessible and visible, and the clo¬ 
sing muscle (the sphincter) should be 
carefully drawn apart and greased 
with oil, vaselin, or lanolin, in or¬ 
der to render the introduction of 
the tube painless. The injected oil 
or water loosens and softens the 
fecal masses, also stimulating the 
movements of the bowel, so that 
after a short time the injection is 
again ejected, more or less inter- 

FlG ' 1 syringe. untain mixed with the intestinal contents. FlGl 1 of'soft rubber ?^ 6 

































































































































































































Enema 

Enuresis 


THE STANDARD FAMILY PHYSICIAN 


304 


This may occur in several efforts, sometimes very shortly after the injec¬ 
tion, in other instances not until several hours have passed. The selection 
of the fluid for the enema must be left to the physician. A lukewarm soap 
solution may be recommended as sufficient for ordinary purposes. Many 
persons gradually learn to administer cleansing enemas to themselves, even 
when standing or sitting. 

Medicinal enemas are given for the purpose of introducing certain rem¬ 
edies into the rectum, from which they are absorbed and become effective. 
The reasons for this method of administering medicines depend upon the 
type of the disease, upon the character of the remedy, or upon the person¬ 
ality of the patient. The medicine in question is dissolved in a small quan¬ 
tity of (usually watery) fluid which is injected into the rectum with a small 
glass or rubber syringe. An insane person, for instance, who refuses to 
take medicines, may be given a narcotic by means of an enema. Med¬ 
icines which are liable to be vomited, especially when they are to be given 
repeatedly, may likewise be readily introduced into the body in this man¬ 
ner. Large quantities of olive-oil are frequently administered by means of 
an enema, as, for instance, in the treatment of gall-stones. If worms are 
present in the lower bowel, enemas are injected which contain narcotizing 
or germicidal substances, such as garlic, tobacco, quassia, gentian, etc. 

Nutrient enemas are employed when a patient is not able to take nourish¬ 
ment in the usual manner; as in cases of a constricted esophagus, or in 
stomach-diseases (as ulcer or cancer) which are accompanied by constant 
vomiting. To prevent progressing emaciation, nourishment is adminis¬ 
tered by the rectum, as this portion of the intestine is capable of absorbing 
fluids and foodstuffs in solution. It is not possible, however, to nourish 
a patient sufficiently or permanently in this manner. At most three-quarters 
of the required amount of nourishment can be administered to a patient by 
rectum; yet, notwithstanding a more or less steady loss of weight patients 
have been kept alive on nutrient enemas for months, even for years. Never¬ 
theless, it is practically only in cases of emergency that this form of feeding 
is practised. As a rule it is not resorted to until the patient takes less by 
mouth than can be administered to him by enema into the rectum. 

The quantity of food in a nutrient enema should be small, but it must 
be of high nutritive value. Numerous experiments have shown that milk 
enemas are among the most suitable. The nutritive value may be in¬ 
creased by the addition of eggs and sugar, or cooked starchy food. The 
addition of wine or brandy is also customary in many cases. It is necessary 
always to add a small amount of salt to an enema in order to facilitate its 
absorption. An excess of salt is, however, disadvantageous. Nutrient 
enemas should not exceed half a pint in quantity, as larger amounts are re¬ 
tained only with difficulty. The food should be heated to body tempera¬ 
ture, and should be introduced slowly and under slight pressure, with an 






305 


THE STANDARD FAMILY PHYSICIAN 


Enuresis 

Enema 


irrigator, a glass funnel, or a syringe. The most suitable position in which 
to place the patient while administering an enema is upon a pillow, with 
raised buttocks, or in a bending position with the elbows resting upon the 
knees. Nutrient enemas should be given two or three times a day, or even 
more if retained well; and they should be preceded, at least in the morning, 
by a cleansing enema, so that the food is not thrown out by an evacuation 
of the bowels. 

ENTERITIS.—See Dysentery; Intestines, Diseases of. 

ENURESIS (WETTING THE BED). —At about the end of the first year, 
or at least during the second, children should be taught how to keep them¬ 
selves dry during both day and night. When normal and mentally sound 
children wet the bed after they are three years of age; this is due to a dis¬ 
turbance which has been termed nocturnal enuresis. This condition occurs 
not only in weak and sickly children, but also in those who are apparently 
in the best of health. It may be due to a variety of causes, as worms, stone 
in the bladder, a contracted prepuce, masturbation, epilepsy, or to en¬ 
largement of the nasal or pharyngeal tonsils. During waking hours the 
child is able to voluntarily retain the urine until a suitable time arrives for 
evacuating the same, but during sleep this control is often lost. Involun¬ 
tary urination occurs, therefore, usually while the child is sleeping, and 
only rarely while it is awake. The urine is freely voided during the first 
few hours after the child falls asleep and less often during the early morn¬ 
ing hours. The act may or may not be followed by the awakening of the 
child; it may be repeated night after night, or at least several times a week. 
There may be longer or shorter intervals of freedom from the symptom, but 
it is very apt to return. If the condition remains uncared for, it may per¬ 
sist for many years, even up to the time of puberty, when it generally dis¬ 
appears of itself, although it has been noted up to the twentieth year. 

The treatment demands some experience and a great deal of patience. 
It must be borne in mind that the condition is rarely due to naughtiness or 
laziness, but that it is much more apt to be due to an inherent weakness in 
the child. Bodily weakness can not be corrected by scolding, ridicule, or 
punishment. On the contrary, this only intensifies the evil by frightening 
the little patient; and later medical treatment is rendered much more diffi¬ 
cult. The following remedies may first be tried. Supper should consist 
of solid food only, without any fluids, unless it be some gruel. For two 
or three hours before bedtime, no fluids of any kind should be given 
to the child. Carbonated waters, tea, and coffee may exert a very del¬ 
eterious influence. The child should go to the toilet immediately before 
retiring. The most suitable thing for the child to lie upon is a hair mat¬ 
tress covered with some impervious material, as a rubber-sheet, or a piece 
of oilcloth. In many cases a cure may be effected by elevating the legs and 
pelvis by placing pillows under them, or better yet, by raising the foot of 







Enzyme 

Epilepsy 


THE STANDARD FAMILY PHYSICIAN 


306 


the bed about fifteen inches. This procedure favors the collection of the 
urine in the upper portion of the bladder, so that a greater amount must 
necessarily accumulate before the opening of the urethra is reached, thus 
rendering more prolonged retention possible. This method, however, cam 
be practised only with older children. 

During the day the child should be instructed to hold the urine for in¬ 
tervals of time gradually increasing from two-three-four-five hours, etc. 
In obstinate cases the child may be awakened several times during the first 
few hours of the night, and urged to urinate. If a child going to school 
suffers from this complaint, he should be permitted to empty the bladder 
frequently, and it is advisable to arrange short recesses between the in¬ 
dividual lessons. If these measures prove insufficient to correct the trouble, 
it may be necessary for the physician to resort to medicine, hypnosis, or 
electricity. Massage of the bladder has been attended with excellent re¬ 
sults in some cases. In weakly children various tonic measures, such as 
baths, exercises, etc., must also be considered. Punishment is only to be 
thought of where laziness can be traced as the cause of the evil, but it is ad¬ 
visable to omit even this as well as all other methods of torture, the appli¬ 
cation of which is intended to prevent a sound sleep. The observation that 
a lateral posture seems less frequently attended with enuresis, has led to 
the practise of tying rough brushes and knotted towels to the child’s body in 
such a manner that the child is made uncomfortable when it attempts to 
lie on its back. This procedure is cruel and unnecessary. Warning must 
be given in regard to the many secret remedies which are claimed to cure 
the condition without fail, but which in reality are entirely inefficacious. 

ENZYME. —See Ferments. 

EPIDIDYMIS. —See Introductory Chapters, 5 . v. Organs of 
Generation (p. 74). 

EPIDIDYMITIS. —Inflammation of the epididymis; an affection most 
frequently arising as a complication of acute gonorrhea (which see), al¬ 
though it may complicate also a chronic gonorrhea. It may occur at any 
time after the onset of the gonorrhea (usually after the second week), and 
is due to an extension of the infection, exercise and sexual excitement being 
factors in aiding this extension. Epididymitis comes on very acutely as a 
rule. There is considerable swelling of the testicle, with intense pain and 
heat. Not every inflammation of the epididymis, however, must be ascribed 
to gonorrhea; there is also a tuberculous affection of the organ, and the 
inflammation may sometimes be caused also by a blow or a fall. Finally, 
an epididymitis due to gonorrhea may be followed by a tuberculosis of the 
organ, particularly if a tuberculous predisposition be present. 

The significance of gonorrheal epididymitis lies in its very protracted 
course (the mildest cases usually persisting two weeks), and the scars 
that remain. A permanent functional disturbance may follow; and if both 







307 


THE STANDARD FAMILY PHYSICIAN 


Enzyme 

Epilepsy 


epididymal bodies become involved in the course of one or several attacks 
of gonorrhea, sterility is not an infrequent result. 

Tuberculous epididymitis usually terminates in suppuration with the 
formation of a fistula. The only possibility of effecting a cure in such 
cases lies in the removal of the testicle and epididymis, provided the body 
is otherwise healthy. 

To limit the chances for the occurrence of gonorrheal epididymitis it is 
advisable to wear a suspensory bandage, to rest as much as possible, and 
to avoid instrumentation and too strong injections into the urethra. If in 
the course of a gonorrhea there occurs a sudden (mostly one-sided) pain 
in the testicles, the patient should at once go to bed and apply cooling com¬ 
presses (cold water is sufficient) until the physician arrives; but the com¬ 
presses must be changed often to be efficacious. It is beneficial also to 
place the affected parts in a raised position, to suspend all local treatment 
of the urethra, and to keep the bowels open by means of cathartics. 

EPILEPSY. —A disease of the nervous system, occurring periodically, 
and characterized by disturbances of consciousness. It is usually, though 
not invariably, accompanied by complete loss of consciousness and by con¬ 
vulsions. All the causes of the disease have not yet been fully determined. 
Heredity is probably of considerable importance in the etiology, for the 
descendants of epileptic, mentally deranged, or alcoholic parents are fre¬ 
quently afflicted with the disease. Alcohol plays a very noteworthy part, 
as about one-third of all chronic alcoholics become subject to epilepsy. 
Marked psychic disturbances, such as a severe fright, may prove the im¬ 
mediate cause for an epileptic convulsion; but this can only happen where 
the system has been prepared, as by hereditary tendencies, etc. A healthy 
normal person never becomes epileptic from fright alone. It is necessary 
to distinguish a primary from a secondary epilepsy, the latter being due 
to an injury to the brain or to the irritation of cicatrices along the nerve- 
roots. The great majority of the epilepsies are due to injuries to the 
brain at birth. The disease may come on at any time of life, but it occurs 
more frequently during childhood and youth. Very often the so-called 
“teething cramps” are of epileptiform nature. 

During a severe seizure the patient falls down unconscious, sometimes 
first uttering a loud cry. The body becomes rigid, the head is bent back¬ 
ward, the limbs are extended, and the face becomes blue owing to the diffi¬ 
culty in breathing. A few moments later the entire body manifests con¬ 
vulsive movements—the head is tossed about, and the limbs are jerked 
violently. Tight contraction of the jaws often produces an injury to the 
tongue, so that bloody froth shows at the mouth. Urine and feces may also 
be voided involuntarily. The attack lasts only a few minutes. The con¬ 
vulsions cease, the body relaxes, respiration again becomes free, and the 
patient awakens without any recollection of what has taken place, the only 





Epilepsy 


THE STANDARD FAMILY PHYSICIAN 


308 


evidence of what has occurred being marked by the lacerated tongue and 
a feeling of fatigue which he experiences. Patients are usually very drowsy 
following an attack. Very often an attack may be presaged by peculiar 
sensations (the Aura) lasting but a few seconds or minutes. These are 
chiefly characterized by a variety of nervous manifestations, rush of blood 
to the head, palpitation, etc. 

Aside from this complete attack there is another and less violent variety 
which is marked by a brief transitory fainting-spell, vertigo, or unconscious¬ 
ness. If these patients are suddenly overcome while reading, eating, or 
otherwise occupied, they will be observed to stare in an absent-minded 
way, and then continue whatever they have been doing as if nothing had 
happened. Of the seizure itself, they are absolutely ignorant. 

An epileptic attack may come on at any time, day or night. Patients 
with nocturnal attacks are often unaware of the condition for a long time. 



Fig. 128. Hospital with 35 beds for acute cases. (Craig Colony for Epileptics) 


A seizure may readily be induced by mental disturbances, exhaustion, or 
by a debauch. Sometimes as many as forty or fifty attacks may occur 
in one day, and may cause death from overexertion of the heart-muscle. 

A single attack, although an alarming sight, does not endanger life. 

The conduct of most epileptics changes during the progress of the dis¬ 
ease. They become irritable, quarrelsome, and egotistic; and if their 
wishes are not satisfied they get very much excited, and even belligerent 
and brutal. A distrustful and insistent manner is often combined with a 
certain amount of bigotry and hypocrisy. Their sense of the truth is often 
blunted, and their oath in court is not to be trusted. In other patients there 
is rather a diminution of mental capacity—a narrowing of their horizon of 
observation; and a certain mental deterioration enters into the foreground 
of their symptoms. In the course of the succeeding years this mental weak¬ 
ness may develop into actual idiocy, especially if the epilepsy was present 
before the development of the mind was fully completed. In addition to , 
the continuous disturbances of the mental functions, the attacks may be 





















309 


THE STANDARD FAMILY PHYSICIAN 


Epilepsy 


accompanied by more transitory disorders of the intellect, in which a cloud¬ 
ing of consciousness is the most marked characteristic. This may go on to 
delirium, with hallucinations, fright, and great excitement. These patients 
are a source of danger, and many homicides are committed by them while 
in an epileptic state. 

The mild disturbances of the intellect (psychic equivalents) are not al¬ 
ways recognized—especially when the severer types are kept in mind— 
because to the untrained observer the patients do not give any outward 
impression of being in any way mentally disturbed. They may merely 
seem somewhat confused or slightly intoxicated; and in this condition they 
may commit various crimes, such as arson, larceny, etc. They are in doubt 



Fig. 129. Section of hydrotherapeutic room, showing operating-table. (Craig Colony for Epileptics) 


as to their own mental status, and search in vain for a suitable excuse for 
their shortcomings. Such excuses as are finally devised are not even ac¬ 
cepted without restrictions by themselves; and they generally wind up their 
statements with the formula “I do not know how I came to do this. Pa¬ 
tients of this kind may undertake prolonged journeys, and when they finally 
come to in some foreign place they are unable to explain how or why they 
got there. It is important for a criminal judge to be acquainted with the fact 
that the recollection of any given act, such as a larceny, may not be erased 
for some short period of time after the crime has been committed, but as 
soon as the cloud over the intellectual faculties is lifted, all memory of the 
act is lost. A prisoner thus afflicted will affirm what he has done while he 
still remains in this morbid state of mind, only to deny every recollection of 
the act when his normal condition of mind returns. It is possible to refer 
to these as instances of double consciousness, similar to those met with in 




























Epilepsy 

Ergot-Poisoning 


THE STANDARD FAMILY PHYSICIAN 


310 


other abnormal mental states such as hysteria, sleep-walking, and hypnosis. 
It is scarcely necessary to call attention to the possibility of simulation in 
these people, but there is no doubt that many epileptics have been unjustly 
convicted of crimes which they committed while under the influence of the 
epileptic attack. It is often a most difficult matter to come to a decision 
in these cases, and a knowledge of insanity is necessary for proper judgment. 

Intoxication in epileptic patients is a serious condition. Even a small 
quantity of alcohol excites them, and renders them dangerous. Some are 
thrown into a condition of fury and brutality by the ingestion of only a few 
glasses of beer. The alcoholic state is likewise followed by a loss of every 
recollection of the event. It must be expressly noted that a case of epilepsy 



Fig. 130. Section of hydrotherapeutic room, showing steam-cabinets and massage-table. (Craig Colony 

for Epileptics) 

may be marked only by the psychic phenomena just described, without there 
having been at any time any evidences of convulsive seizures. The mental 
disturbances of the kind described, and not the convulsive attacks, are 
therefore the essential characteristics of epilepsy. 

Epilepsy is very often a curable disease. Sometimes it disappears with¬ 
out any definite method of treatment having been used; and this accounts 
for the occasional “cures” by quacks. The latter have largely exploited 
this field of medicine, and all the nauseating remedies which characterized 
the pharmacopoeia of the middle ages have been and are still being employed 
by them. But only one drug has withstood the stress and storm of medi¬ 
cal criticism, and that is bromin and its derivatives. These preparations 
should always be given under medical supervision in order to obtain the de¬ 
sired effects; they should therefore never be recommended carelessly among 
the laity, who may employ them without the exercise of any discretion. 



















311 


THE STANDARD FAMILY PHYSICIAN 


Epilepsy 

Ergot-Poisoning 


Nor should any attention be paid to the statements of quacks who publish 
tirades against the bromides, and label them as poisons, yet incorporate 
them in their own secret preparations. The necessity for direct medical 
supervision must not only be extended to the giving of the drug, but also 
to the manner of living, for one is a necessary accompaniment of the other. 
Many an epileptic might have been cured if these admonitions had been 
obeyed. Diet and open-air occupations are of even more importance than 
the bromides. 

Epilepsy originally due to injuries to the nerves or the brain, may some¬ 
times be cured by surgical procedures. The hope has been entertained that 
primary or idiopathic epilepsy might be similarly benefited, but thus far no 
results of any consequence have been secured. 

Dangerous epileptics must be confined in institutions organized for this 
purpose, and this also applies to those who are mentally weak and help¬ 
less, unless provision can be made for them in their homes. In the United 
States, epileptics are only too frequently herded with almshouse patients 
or with the insane. Such treatment is neither economically nor medically 
justifiable. New York state has led the way in the founding of the Craig 
Colony for Epileptics, at Sonyea, an enlightened and just manner of 
dealing with this class of defectives. Fortunately other states are following 
the lead. 

As a rule an ordinary attack of epilepsy can not be aborted. All that 
can be done is to remove all tight articles of clothing, to place a pillow under 
the patient’s head, and to take care that he does not injure himself in his 
convulsive struggles. All attempts made with the object in view of re¬ 
lieving the convulsive rigidity of the fingers or limbs are of no value what¬ 
ever; neither may anything be accomplished by sprinkling the patient with 

cold water. 

EPSOM SALTS.—See Magnesium, Salts of. 

ERGOT-POISONING.— Ergot is a poisonous, mold-like fungus which 
grows over and into the gram of rye and lcplaces its substance. It is a 
horn-shaped, usually curved body, dark violet on the outside and white 
inside; and it is most poisonous immediately after the harvest. Rye in¬ 
fected with ergot is often ground into flour and used for food (particularly 
in impoverished countries), with the result of acute or chionic poisoning. 
During the middle ages, in years when the crops were bad and widely in¬ 
fected, veritable epidemics of ergot-poisoning occurred. 

The symptoms of acute poisoning by ergot aie chiefly connected with 
the gastro-intestinal canal, as salivation, retching, vomiting, and diarrhea; 
and with the nervous system, as itching sensations resembling the creeping 
of ants on the arms and legs, headache, and vertigo. In some severe at¬ 
tacks, convulsions, delirium, and unconsciousness may occur. The poison¬ 
ing terminates in recovery in a few days, rarely in death. 




312 


Erg-ot-Poisoning 

Eruption 


THE STANDARD FAMILY PHYSICIAN 



Chronic ergot-poisoning ( ergotism ) is observed in two chief forms. True 
ergotism is characterized principally by a most annoying itching in fingers 
and toes, also in the trunk and limbs, and by extremely painful muscular 
spasms which may be aggravated to epileptiform convulsions and lock¬ 
jaw. A second general type, gangrenous ergotism , shows symptoms of 

itching, pains in the back, and convulsions, 
followed by dry gangrene of the fingers or 
toes, which may even drop off. Not only 
fingers and toes, but also hands, feet, arms 
and legs may suffer by this dry gangrene. 
The timely suspension of the use of food¬ 
stuffs containing ergot stays the disease, 
and recovery takes place. Continued use 
of such foodstuffs, on the other hand, will 
lead to protracted illness, and may even 
cause death under symptoms of convulsions 
and exhaustion. Even in cases of benign 
course, however, there may remain trem¬ 
bling and numbness of the fingers, curvature 
of the limbs (see Fig. 132), and weakness of 
the nervous system. 

At the first sign of poisoning, the inges¬ 
tion of food containing ergot must be 
stopped, and a physician should be con¬ 
sulted. Bread containing ergot is usually 
damp, and full of violet spots; it smells dis¬ 
agreeably, and leaves an unpleasant, tick¬ 
ling sensation in the throat. The disease 
is prevented by careful cleansing of the 
grain, and by cautioning and instructing 
the populace. Owing to improved methods 
of cultivation, strict hygienic inspection, 
and to the importation of sound grain dur¬ 
ing years of failure of the crops, epidemics 
of ergotism are now rare. In Russia, Italy, 
and Spain they still occur, less frequently in other parts of Europe, while 
this form of poisoning is practically unknown in the United States. 

ERUCTATION.—Belching of wind; one of the most frequent and disa¬ 
greeable evidences of gastric disturbance. The material belched forth 
consists of air or of various gases—nitrogen, hydrogen, carbonic acid, sul- 
fureted hydrogen, etc. Air is always to be found in the stomach, being 
swallowed alone or with the food. The other gases are formed in the stom¬ 
ach by the fermentation or putrefaction of various food remnants. In a 


Fig. 13 i. Ergot. 

A. Rye with infected grains. B. An in¬ 
fected grain, enlarged. C. The sprout¬ 
ing fungus. D. Enlarged head of fungus. 










313 


THE STANDARD FAMILY PHYSICIAN 


Ergot- Poisoning 
Eruption 


normal, healthy stomach there is practically no stagnation of the contents, 
and bacterial disintegration does not take place. Fermentation is usually 
the result or accompaniment of gastric weakness, especially of dilatation 
of the stomach. Very often acids (hydrochloric, acetic, etc.) are also belched 
forth, and may be recognized by their acrid or burning taste when they 
enter the mouth. These acids are evidences of fermentation of the con¬ 
tents of the stomach. The eructation of air, as a rule, is only the result 
of abnormal nervous irritability of the stomach, and therefore has not the 
same importance attached to it as the belching of other gases or acids. The 
so-called heartburn, which is also a form of acid eructation, may be asso¬ 
ciated with nothing but a hyperacidity of nervous origin. It is a not in¬ 
frequent accompaniment of hasty eating, particularly if a large part of the 
diet has consisted of hot bread and fatty foods. 

The difference in the varieties and causes of this condition makes it 
evident that there can be no single method of overcoming it, but that treat¬ 
ment in each instance must be directed to the original causative factor. 
Where gastric fermentation is present, it is necessary first of all to improve 

the atonic condition of the stomach. This 
may be accomplished by washing out the 
stomach, in addition to other methods. In 




Fig. 132. Deformities caused by chronic ergot-poisoning. 


acid fermentation the hyperacidity may be neutralized by various alkaline 
remedies, such as bicarbonate of soda, and by strict adherence to a pre¬ 
scribed diet. In all cases it is extremely necessary to regulate the bowels 
carefully. Sedatives are often useful in the nervous variety of eructation. 
The details of treatment should always be referred to the medical attendant. 

ERUPTION.—A general term for changes in the skin which are more 
or less circumscribed, and which run a well-marked course. According to 
their form and behavior they are designated as macular , papular , or vesicu¬ 
lar eruptions. This does not afford a sufficient distinction, however; for 
there are many eruptions which are similar in form, but which differ in 
their origin and course. Maculae may be red, bluish-red, yellow, brown, 
or white. Flat, red macuke which project slightly above the level of the 
surrounding skin are known as hives or urticaria. Papulae are fum, cii- 
cumscribed elevations of the skin, and their shape may be round, ciescent, 
oval, or otherwise. Vesicles and blisters are elevations of the thin, outer 
layer of the skin, and are filled with fluid. If the fluid dries up, a crust ic- 









Erysipelas 


THE STANDARD FAMILY PHYSICIAN 


314 


suits. A similar crust is formed by the drying of the blood and serum 
which comes from a superficial abrasion. Certain eruptions consist of 
cast-off portions of the epidermis mixed with the oily matter from the skin, 
and collected in scales. The condition known as dandruff is an example of 
this form of eruption. 

ERYSIPELAS (ROSE-RASH).—An inflammatory disease of the skin, 
accompanied by fever, and caused by the entrance of certain micro-organ¬ 
isms {cocci). It always starts from an injured part of the skin or mucous 
membranes; either from a more extensive wound or from an insignificant 
abrasion which is apt to be overlooked. The open wounds may be the 
result of injuries, of childbirth, of infection of the navel in the newborn, or 
of operations; or they may be due to scratching or needle-pricks. 

The most frequent form of this disease is erysipelas of the face, which 
usually originates in the injured mucous membrane of the nose. It is 
not always necessary, however, that an injury precedes the occurrence 
of erysipelas. The entrance of the bacteria may be favored by disorders 
which cause a break in some part of the skin or of a mucous membrane, 
such as skin eruptions of the nose or ears, fetid nose (ozena), discharge 
from the ears, and coryza. Many persons who are periodically affected by 
erysipelas suffer from such disorders, and escape the erysipelas when the 
original complaint is cured. Fright and colds are not factors in causing the 
affection. Epidemics of erysipelas were formerly frequent in the surgical 
wards in hospitals, but following the discovery of the cause of the disease, 
they have become rare. 

The first symptom of erysipelas is usually a violent chill, followed by 
high fever. Soon afterward there appears on the skin a red, painful, ele¬ 
vated spot which rapidly increases in size, advancing either with round con¬ 
tours or in tongue shape. In many patients the onset of the inflammation 
of the skin occurs simultaneously with the fever. The affected skin is painful 
to the slightest touch. It is pink to copper-colored, smooth, glistening, 
tense, and hot. A striking characteristic is the sharp definition of the in¬ 
flammation, the affected parts being sharply demarcated from the healthy 
skin. When the affection spreads over the entire body, or over the greater 
part of the body, it is spoken of as wandering erysipelas. Erysipelas of the 
face or head rarely advances further downward than to the nape of the 
neck. Usually it is restricted to the face, the ears, and the hairy part of 
the head. 

The duration of the inflammation is from four to five days, sometimes 
longer. The outer skin is then cast off in small bran-like scales or in large 
flakes. Mild infections usually heal in a few days; cases of medium se¬ 
verity require about a week. In very rare cases the disease may last more 
than two weeks. An exception to this rule is seen in wandering erysipelas. 
If the poison of the disease is marked, severe general symptoms develop. 






315 


THE STANDARD FAMILY PHYSICIAN 


Erysipelas 


There may be violent headache, delirium, and stupor; the tongue is dry 
and covered with crusts; the appetite is lost. In rare cases complications, 
such as meningitis, pleurisy, or inflammation of the kidneys, may constitute 
serious dangers. As a rule, however, the course of the affection is a favor¬ 
able one. Erysipelas is distinguished from the exanthemata (measles, 
scarlet fever, etc.) in that recovery from an attack does not make the patient 
immune to subsequent infections. On the contrary (as is often the case 
also with articular rheumatism and bronchopneumonia), a diminution in 
the power to resist the affection is noted. 

As to the treatment, it is in many cases unnecessary to resort to energetic 
measures. It is sufficient to relieve the painful tension and the suscepti¬ 
bility to drafts of air by a plentiful application of oil, vaselin, or cold-cream 
to the skin, and by covering the same with a warm dressing. Dusting- 
powders may be used instead of fats. Cooling drinks (selters, lemonade, 
etc.) may be useful in allaying the fever, and an ice-bag to the head is grate¬ 
ful. Attention must be paid to regular movements of the bowels. The 
falling-out of the hair does not require any special treatment, as it grows 
rapidly upon recovery. A marked sensitiveness and irritability of the skin 
often remains for some time after the disease-process has ceased. It is 
wise, therefore, to protect the skin on first exposure to the air. 

Although the affection often heals spontaneously without treatment, 
it is always necessary to consult a physician. In the first place it is of 
paramount importance to determine whether the affection is actually ery¬ 
sipelas. If not, the physician can reassure the patient and his friends, and 
thus spare them unnecessary excitement. 

Erysipelas and conjuration are intimately correlated in the beliefs of 
many people, and it is the opinion of the superstitious that a sufferer from 
that disease must needs have it conjured in order to be cured. This belief 
is widely disseminated, particularly in European countries, not only among 
the rural population, but also among the dwellers in cities. It is not at 
all rare that the physician pays his visit in the morning, while in the after¬ 
noon the “wise woman” murmurs her magic words at the patient’s bedside. 
It seems almost unnecessary to say that conjurations or charms are abso¬ 
lutely without any effect. Every insignificant inflammation, every inno¬ 
cent red spot on the skin, may be mistaken for the much-dreaded erysipelas. 
Such slight disorders disappear rapidly and spontaneously. Also mild 
forms of erysipelas may heal in a few days without having caused any se¬ 
vere symptoms. In such cases the patient usually waits for two 01 three 
days before sending for a “wise woman,” and it may frequently happen 
that the spontaneous disappearance of the disease takes place simultane¬ 
ously with, or soon after, the administration of the magic tieatment. It 
being the inclination of human beings to ascribe every occurrence to a vis¬ 
ible and tangible cause, the patient will rather connect the improvement 






Esophagus 


THE STANDARD FAMILY PHYSICIAN 


316 


in his condition with the conjuration or charm or “absent treatment” which 
he is able to see or hear, than with the forces of nature which work silently 
in his body. For this reason superstitious patients often deceive themselves 
as to the cause of the improvement. 

The prevention of the disease may in many cases be accomplished by 
protecting fresh wounds from contamination, and by timely treatment. 
The physician should be consulted as early as possible; as for instance when 
the navel-wounds of nurslings have an unhealthy appearance. It is of the 
highest importance that all rooms which have been occupied by erysipelas 
patients, or in which they have been treated, should be thoroughly disinfected. 
The bacteria of erysipelas are possessed of great vitality and resistance. 
They are difficult to kill, and may remain adhering to the walls or to the 
floor of the sick-room, causing the disease to appear in susceptible indi¬ 
viduals, or to recur in persons previously affected. It is a criminal thing 
for a person with erysipelas, even of the mildest type, to come anywhere 
near a recently confined woman. The chances are very grave that the 
uterus may be infected with the erysipelas-germ, and that blood-poisoning 
will develop, possibly with deadly consequences. 

ESOPHAGUS, DISEASES OF. —The esophagus, or gullet , is a membra¬ 
nous tube about nine inches in length, which is connected with the stomach, 
and which serves as a passageway for food (see Introductory Chapters, 
5. v. Organs of Digestion [pp. 55-56]). It is subject to a number of 
affections, which may be caused either by the material ingested, or be due 
to morbid changes in its various tissues. 

Cancer is the most frequent and dangerous of all diseases of the esopha¬ 
gus. The tumor is generally situated where the esophagus enters the stom¬ 
ach; sometimes its site may be in the middle, rarely at the beginning of the 
gullet. Cancer develops very slowly, insidiously, at first hardly perceptibly. 
It may often exist for months before difficulty in swallowing sets in. On 
account of the increasing stricture of the esophagus, this difficulty becomes 
more and more marked until only liquids will pass, and finally not even 
these. The danger of starvation can be avoided only by artificial feeding 
through the rectum, or by gastrostomy. Up to the present time medical 
skill is perfectly helpless when confronted with cancer, and even surgery is 
not yet able to remove these growths from the esophagus. 

Contractions of the esophagus occur principally in consequence of cor¬ 
rosion of its mucous membrane by acids or alkalies which have been drunk 
either with suicidal intent or by accident. This causes ulcers which heal 
as scars. These scars contract the caliber of the esophagus and cause 
difficulty in swallowing; at times this may be so severe that it becomes 
impossible to take food, and the patient is in danger of starvation. 
Sometimes the physician succeeds in gradually enlarging the contracted 
parts by stretching the esophagus. At other times, however, it becomes 







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PLATE VIII. 

A. ARTERIES AND MUSCLES OF THE ARM AND HAND 


1 . 

Triceps muscle 

6 . 

Pectoralis major muscle 

2 . 

Superficial flexor muscles of the hand 

7. 

Axillary artery 

3. 

Ulnar artery 

8 . 

Brachial artery 

4. 

Superficial palmar arch 

9. 

Biceps muscle 

5. 

Deltoid muscle 

10 . 

Radial artery 


11. Deep palmar arch 


B. ARTERIES AND MUSCLES OF THE THIGH 


1. External oblique muscle of abdomen 

2. Tensor muscle of the inner fascias of the 

thigh 

3. Quadriceps extensor 


4. Inguinal canal 

5. Femoral artery 

6 . Adductor muscles of thigh 

7. Sartorius or tailor-muscle 


8 . Patella (kneecap) 


/ 


6 







Plate VIII 









































































































































317 


THE STANDARD FAMILY PHYSICIAN 


Esophagus 


necessary to perform the operation of gastrostomy in order to nourish the 
patient. 

Dilatations are situated chiefly in the upper, seldom in the lower part 
of the esophagus. They cause difficulty in swallowing, because the food 
may remain for hours and days in these dilatations, thereby obstructing 
the passage. The food often decomposes, and produces a foul odor. It 
may finally be vomited up. Generally the only cure is found in operative 
treatment. 

Spasm of the esophagus is always of nervous origin; generally speaking, 
it is a rare sign of nervous weakness. The symptoms, which are nearly 
identical with those of real contraction of the esophagus, consist in trouble in 
swallowing the nourishment taken, even fluids. .The spasms come and 
go, their appearance being very uncertain. It is a tedious but harmless 
complaint, which generally yields to proper medical treatment. 

ESOPHAGUS, FOREIGN BODIES IN.—Foreign bodies not infrequently 
find their way into the pharynx or the esophagus. Teeth, teeth-plates, 
bones, needles, fish bones, etc., are often swallowed accidentally, and may 
remain in the pharynx or in the muscular wall of the esophagus, generally 
lodged sideways. They cause contraction of the esophagus, and more or 
less severe trouble in swallowing; at times they may give rise also to in¬ 
flammation and suppuration of the wall of the esophagus. If the foreign 
bodies do not fall accidentally into the stomach, or are not ejected by vom¬ 
iting, it is best to try to displace them by encouraging vomiting. This may 
be accomplished by tickling the pharynx with the handle of a spoon, or by 
introducing the finger. It may sometimes be possible to grasp the foreign 
body with the fingers, and thus to remove it. If these attempts are fruit¬ 
less, and if the patient is suffocating, place him with his chest toward the 
wall and strike his back with short strong strokes between the shoulder- 
blades. The air which is thus forced from the lungs may carry the foreign 
body with it if it be lodged at the junction of the windpipe and esophagus. 

If the object has already been swallowed, as will be seen from the fact 
that the patient can eat and drink without hindrance, he should be allowed 
to eat plentifully of cooked potatoes, so as to envelop the possibly pointed 
or sharp object, and thereby avoid injury. Swallowed coins are generally 
harmless, and pass with the stools. No time should be lost before sum¬ 
moning a physician, who, with his technical knowledge, and with the aid 
of special instruments, can generally remove the object quickly, or if 
necessary thrust it into the stomach; while the layman would be making 
fruitless endeavors. If needles or other dangerous articles have been swal¬ 
lowed, and if they do not pass after a few days, operative removal may be 

necessary. 

The swallowing of objects could often be avoided, for instance, by 
removing artificial plates from the mouth before retiring, by eating more 






Essential Oils 
Exercise 


THE STANDARD FAMILY PHYSICIAN 


318 


carefully, and by abolishing the habit of holding pins and the like between 
the teeth. 

ESSENTIAL OILS.—See Oils, Volatile. 

ETHER, ACTION OF.—Ether acts as alcohol, and others of the marsh- 
gas series, but being more diffusible its effects come on much more rapidly 
and are recovered from more quickly. Its main actions are primarily to 
impair consciousness, then to cause muscular excitement, then loss of mus¬ 
cular power, and finally anesthesia and loss of all sensation. It is important 
that ether-vapor be given well diluted, otherwise is may induce very danger¬ 
ous collapse. When a patient is fully under the influence of ether, the heart- 
action is slightly slower than normal, as are also the respirations. The body 
is flushed and warm; blueness indicates trouble with breathing. The pupils 
are moderately contracted and all consciousness is lost. The involun¬ 
tary movements of a patient, as well as the cries and groans that he may 
utter during an operation, are the results of the narcotic, and not the re¬ 
sponse to painful sensations. Patients should not take ether immediately 
after having eaten, as ether often brings on vomiting attacks, which may 
cause suffocation. Patients with false teeth should always inform the phy¬ 
sician of this fact before being anesthetized, so that they may be removed. 
Following anesthetization, patients are often sick at the stomach. Cracked 
ice, carbonated waters, cold champagne, etc., are useful in the treatment 
of this condition. Etherization is a very safe procedure, and should not 
occasion any special fear on the part of the patient. See also the article 
on Anesthetics. 

EUCAIN.— See Cocain. 

EUCALYPTUS.—The dried leaves of Eucalyptus globulus , a large forest- 
tree which is native in Australia, and extensively planted in India, Italy, 
California, and other tropical and subtropical regions. The active prin¬ 
ciple of the leaves consists of a volatile oil of very complex structure. It 
has the characteristic action of other volatile oils, being a powerful anti¬ 
septic, deodorant, and irritant. It is largely used for nose and throat medi¬ 
cation in the treatment of various forms of catarrh of those regions. It has 
been assumed that the eucalyptus-tree is capable of curing malaria, but this 
is an erroneous belief which has its origin in the circumstance that mosquitoes 
are rarely observed in the neighborhood of these trees. The reason for 
this, however, is that the eucalyptus-tree, being a very active and rapid 
grower, and having very large leaves, can absorb immense amounts of 
water. In common with other large trees, it is capable of drying up marshy 
places, thereby eliminating the breeding-places of the mosquitoes, and con¬ 
sequently the mosquitoes themselves. The dearth of mosquitoes, especially 
of certain forms, brings about the elimination of malaria; but the digging 
of ditches and the thorough drainage of the marshes would secure the same 
results as the planting of the eucalyptus. The effect is not due to any vital 






319 


THE STANDARD FAMILY PHYSICIAN 


Essential Oils 
Exercise 


property of the tree, but solely to its ability to absorb large quantities of 
water from the ground. 

EUONYMUS.—A large shrub, Euonymus atvopuvpuveus , grown abun¬ 
dantly east of the Mississippi; the dried bark of its root is used in medicine 
as a cathartic. Its active principles are bitter substances. Euonymin, 
considered to be a glycosid, is a very active stimulant to the flow of bile, and 
it is through its irritation of the intestinal tract that it serves as a cathartic. 

EUPATORIUM.—The dried leaves of Eupatorium perjoliatum (bone- 
set, or thoroughwort), a plant very widely distributed throughout the United 
States. In popular medicine it is used extensively in the form of an in¬ 
fusion of the leaves, which contain a trace of volatile oil, resin, and bitter 
glycosides of uncertain composition. Used in a hot infusion, the action of 
the heat and the volatile oil is that of a quickly diffused stimulant, causing 
increased flow of urine, and increased perspiration. Boneset is therefore 
utilized to aid in the breaking-up of a cold. It is also a mild cathartic and 
emetic. 

EUSTACHIAN TUBE, CATARRH OF. — The passage by which the 
ear communicates with the nasopharyngeal space is called the Eusta¬ 
chian tube (see Fig. 60). All acute inflammations of the nose and of the 
pharynx (especially coryza and tonsillitis), as well as enlargement of the 
nasopharyngeal tonsil, inflammations and ulcers in the nasopharynx, and 
polypi of the nose, may cause an obstruction of the Eustachian tube; this 
will prevent sufficient ventilation of the middle ear, and produce a sensa¬ 
tion of fulness and dulness in the ear, impairing the acuity of hearing. No 
serious disturbances remain if the catarrh is cured in time and its cause re¬ 
moved. See Ear, Diseases of. 

EXCITEMENT.—In the healthy person the mental condition designated 
by this name is merely transitory, but if prolonged or frequently repeated, 
it may become a true psychic disturbance. This pathological state of ex¬ 
citement often appears as a symptom of considerable importance in many 
nervous, hysterical, epileptic, alcoholic, and other mental diseases. Under 
certain circumstances it may lead to a condition of actual confusion, in 
which the patient may do harm not only to himself but also to others. It is 
advisable to keep such persons under appropriate supervision, by the aid of 
two nurses if possible. They should be put to bed and kept there, as com¬ 
plete rest in bed affords one of the best means of combating this state of 
excitement. In addition, warm baths and hot packs are also of value. Of 
drugs it is sometimes found necessary to employ various sedatives and 
hypnotics. 

EXERCISE.—Rest and activity constitute the two great antitheses of 
medicine, upon the alternation of which the life of every portion of the body 
depends. The rules for rest and exercise are among the most difficult 
problems concerning which the physician must decide. Rest is enjoined in 





320 


Exophthalmic Goiter THE STANDARD FAMILY PHYSICIAN 

cases of severe illness or chronic disease, in order not to weaken the system, 
and to afford an opportunity for new energy to be gathered. During the 
progress of the recovery, exercise is again gradually taken up. In any 
given case of illness these questions always arise: when shall the patient be 
allowed to sit up; when may he leave the bed; when may he walk about 
the room; and finally, when shall he be permitted to leave the house? 

The length of a walk must be carefully determined, taking into account 
the weather conditions as regards temperature, humidity, and the wind. It 
should be firmly impressed upon the patient that, in medicine at least, one 
walk of half an hour is a great deal more exercise than two walks of fifteen 
minutes each. Later on these walks, which may be taken indoors during 
unfavorable weather, may be supplemented by respiratory exercises. As 
a rule the pace should be set at 80 steps to the minute, weaker patients 
taking but 60 steps, and those more robust from ioo to 120 steps. Breath- 
ing may be regulated in accordance with the number of steps. For ex¬ 
ample, the act of inspiration may be made to extend over three steps, and 
expiration over another three steps. Finally permission may be given to 
do some climbing, but the ascent at first must be very mild in degree, and 
here also the respiratory movements may be accommodated to the number 
of steps. Oertel recommends an inspiration extending over one step and 
the succeeding expiration including two steps. The climbing of stairs re¬ 
quires the greatest amount of exertion. 

Proper exercise is necessary, not only for those who are or have been 
ill, but also for those in good health. A well person remains so if every 
organ is regularly active. Organs which are not thus exercised, soon de¬ 
generate. Those persons who live close to nature, as it were, must of ne¬ 
cessity exert themselves bodily in order to provide for their daily wants; but 
a large number of individuals, because of the altered conditions brought 
about by modern civilization, are called upon to take but little bodily 
exercise, and perform most of their tasks in closed rooms. This applies 
particularly to persons who follow some calling where mental activity pre¬ 
dominates, and of these there are many in our modern cities. Even our 
periods of recreation are very apt to be spent indoors, and are not char¬ 
acterized by any bodily exertion, for most people remain at home, or seek 
entertainment at public places of amusement. 

Persons who follow sedentary pursuits take but little bodily exercise, 
and it is incumbent upon them to find some substitute for the labor which 
was formerly demanded by nature. Gymnastics and outdoor sports meet 
this requirement to a large extent. The hours of labor in almost all occu¬ 
pations take up about one-third of the day, and after allowing a sufficient 
time for rest and sleep there remains a certain number of hours which may 
be devoted to recreation and amusement. The importance of devoting 
a portion of this time to regular bodily exercises must not be underestimated. 












321 


THE STANDARD FAMILY PHYSICIAN Ooiter 


The variety of exercise is to some extent immaterial, whether it be walking 
or some other form of activity, so long as it is done with regularity. All 
who follow this advice will soon note the physical benefits derived. The 
various groups of muscles are brought into a condition of constant tension, 
although this varies in degree. This tension induces a continuous irrita¬ 
tion of the sensory nerves within the substance of the muscles, and this 
irritation is transmitted through the spinal cord to the brain where it is 
communicated to the nerve-cells. From these the impulses are sent back 
to various parts of the body, affecting particularly the blood-vessels and 
the heart. The arteries in the vicinity of the active muscles are dilated, 
and an increased amount of blood finds its way to the limbs which are in 
motion. 

The heart is influenced in three ways. In the first place the individual 
beats are lengthened; secondly, they become stronger and more efficient; 
and thirdly, the cardiac muscle is brought into a condition of tension. On 
this condition of alternating muscular and nervous activity depends the 
well-being of the body. Mens sana in cor pore sano (“a sound mind in a 
sound body”) is a quotation which applies as well to-day as it did in an¬ 
tiquity. An unnatural mode of life, combined very often with insufficient 
exercise, has resulted in a loss of health to many persons, and the proper 
exercise of the body will restore a great many of these to a normal condi¬ 
tion. In conclusion it must be urged upon all who are healthy, to cultivate a 
regular system of exercise as far as the spare time at their disposal allows, 
and if possible it should be carried out in the open air. 

EXHAUSTION. —This term is applied to the feeling of general bodily and 
mental fatigue which usually follows severe bodily or mental exertions, pro¬ 
longed sleeplessness, continued excitement, forced marches, athletic or 
sexual excesses, alcoholic indulgences, and all other influences which do 
harm to the body, such as hemorrhages and convulsive seizures. Enforced 
rest, and avoidance of the cause of the trouble, are the principal curative 
measures which aid in restoring the normal condition of the system. Cool 
baths and sponging, fresh air with plenty of sunlight, and short walks are 
also to be recommended. Exhaustion may usually be avoided by a sen¬ 
sible adherence to alternating periods of work and relaxation. A different 
cause, however, underlies those conditions of apparent fatigue which pre¬ 
cede the appearance of a contagious disease, before the nature oi the latter 
can be determined. These are merely the evidences of an infection, and 
are usually marked by pain in the joints, disinclination to any effoit, de¬ 
pressed spirits, and other indefinite signs. In such cases it is well to call in 
a physician. 

EXOPHTHALMIC GOITER (known also as BASEDOW’S DISEASE, 
and as GRAVES’ DISEASE).— Morbid protrusion of the eyeballs, with 
goiter, and disordered action of the heart. The disease was described in 





Exophthalmic Goiter THE STANDARD FAMILY PHYSICIAN M 2 

by© _ 

1843 by a German physician, Basedow, and also by Graves, an Englishman. 
It usually appears in families where there is present a tendency to nervous 
diseases, and the hereditary element can often be directly traced. The 
affection is found more often in women than in men, and usually comes on 
during the early years of adult life. Its appearance is in many cases pre¬ 
ceded by conditions which nun down the system, by severe diseases, by sub¬ 
jection to intense mental excitement, and by overexertion. The trouble 
begins with palpitation and a sense of internal unrest, and with tremors, 
debility, and weakness. After a time the characteristic evidences of the 
disease appear: a moderate enlargement of the thyroid (, goiter ), and the 
forward displacement of the eyeballs ( exophthalmos ). It often happens 
that the disease is not recognized before it reaches this point. A feeling of 
internal heat and immoderate perspiration now set in; the sleep is inter¬ 
fered with; and the appetite soon becomes poor. The patients usually 
become very thin, and a number of nervous and mental symptoms appear. 
The subjects are irritable, their memory is poor, and this condition may 
even go on to melancholia and insanity. There is almost invariably rapid 
and irregular heart-action. The most marked sign, which is evident to the 
unpractised eye, is the protrusion of the eyeballs, so that the white of the 
eye seems very large (Plate XVIII. Fig. 1). The disease develops slowly 
and has a very chronic course, periods of improvement alternating with 
aggravated conditions. The sense of internal heat prompts the patients to 
don very light clothing; they prefer to keep cool, and like to sit at the open 
window. 

In the treatment of this condition, the patients must be protected from 
harmful influences, and should avoid all mental excitement. In most cases 
this advice can be followed only with difficulty. A life in the country, 
particularly in the mountains, is to be recommended; or else a term of 
treatment in the proper kind of sanitarium. Care must be taken not to 
subject the patient to too many “cures.” Among the remedial measures 
may be mentioned mild hydrotherapeutics, cool baths, half baths, the 
application of electricity to the neck, and simple but nourishing food, con¬ 
sisting mainly of milk and vegetables. In addition to these, medical treat¬ 
ment is necessary. The use of the thymus gland (not the thyroid) of the 
sheep has been credited with success; but the more modern treatment with 
specially prepared blood-serums from animals will probably be attended 
with a better outcome. In severe cases, where the goiter is very large, 
surgical interference, by which the gland is diminished in size, may be con¬ 
sidered necessary; but this should not be resorted to until all other methods 
of treatment have failed. It should be borne in mind that worry about the 
condition is one of the most frequent causes of the rapid, irregular heart- 
action. If patients suffering from this disease would resolutely still their 
fears concerning themselves, they would aid the physician very materially 








323 THE STANDARD FAMILY PHYSICIAN ^ophthalmic Goiter 


in the treatment (see Dubois, The Psychic Treatment oj Nervous Disorders, 
New York, ioos; pp. 13, 2s, S06). 

EXPECTORATION.— See Sputum. 

EYE.— For structure see The Organs of Special Sense, in Intro¬ 
ductory Chapters (pp. 68-70). 

EYE, CARE OF. —The eye is one of the most sensitive nerve-organs 
of the body. Its systematic care must therefore be counted among the most 
important hygienic necessities, and it is to the individual interest of every 
one to consider this a duty. What may be said in a general way of the care 
of the normal eye, may be applied with more insistence to the diseased eye. 

As soon as the child is born, the eyes must be carefully inspected, and 
cleaned with fresh, clean, absorbent cotton and lukewarm, previously boiled, 
water. To prevent the dangerous inflammations of the eyes of the new¬ 
born, the physician or midwife may drop a few drops of a solution of 
nitrate of silver into each eye (Crede’s method). If, in spite of these precau¬ 
tions, inflammation sets in, no time should be lost in summoning a physi¬ 
cian, as a large number of cases of blindness can be traced to this condition. 
Although the eyes of the new-born baby should be shaded from too strong 
a light, this does not mean that all light and air should be excluded. 

In young children, sometimes even at a tender age, inflammations of the 
conjunctiva and the cornea appear, in connection with eruptions on the 
face and head and enlargement of the glands. These are usually of a scrof¬ 
ulous nature, wherefore not only the eyes should be treated locally, but 
general medical treatment should be instituted, including the administra¬ 
tion of tonics, appropriate diet, cod-liver oil, fresh air, etc. In various 
diseases of children (as scarlet fever, chicken-pox, and measles), the eyes 
also become inflamed; but these cases do not require any special treatment, 
it being usually sufficient to darken the room, without, however, cutting 
off the supply of fresh air. When the child becomes old enough to work 
and play out-of-doors, all work which puts a strain on the eyes should be 
avoided. In buying picture-books, preference should be given to those 
with large and plain pictures, which do not require too much attention to 
little details. 

The entrance into school constitutes the most dangerous period for the 
child’s eyes. It behooves the physician, the parents, and the school au¬ 
thorities to unite in their efforts to prevent the occurrence of near-sighted¬ 
ness, a school-disease in the true sense of the word. School-rooms must 
be high and provided with large windows, arranged in such a manner that 
the light is distributed uniformly and sufficiently. A very bright light must 
be subdued by proper shades. The hours of work should be alternated 
with regular periods of rest. The school-benches must be so constructed 
that they do not make it necessary for the child to lean forward 01 to one 
side in order to reach his desk. The pupil should sit straight in front of 




Eye 


THE STANDARD FAMILY PHYSICIAN 


324 


the desk when writing. The type used in books should be sufficiently large 
and plain, and liberal spaces should separate the individual letters, words, 
and lines. Proper attention to these details should also be insisted upon in 
the home. The erect position may be favored by proper work-benches or 
desks, which should fulfil the following requirements (see Figs. 133, 134): 

(1) They must be so con¬ 
structed as to allow the feet 
of the pupil to rest comfort¬ 
ably on the floor; (2) a space 
of several finger-breadths 
must intervene between the 
hollow of the back of the 
knee and the edge of the 
bench; (3) the seat on which 
the child sits must project 
inward beyond the edge of 
his desk; (4) the desk or 
table should be at such a 
distance above the bench, 
that the child can rest his 
arms comfortably upon it 
while sitting upright; (5) the 
table should be neither too 
high nor too low. The win¬ 
dow, or whatever artificial 
source of light is used, 
should be on the left hand 
of the desk or work-bench, 

Fig. 133. Correct attitude when writing. 

in order that the shadow of 
the hand may not fall on the writing-surface. Artificial light, a necessary 
evil, must be uniform and steady; a flickering or glaring light should not 
be used. If necessary, the eyes may be protected from the direct rays of 
the light by a green shade, or better, by attaching a suitable globe to the 
lamp or gas-burner. 

Alternating periods of rest and work must be insisted upon also at home, 
and the eager reading of story books and novels, usually very poorly printed, 
should be forbidden. The reading of music notes, and the production of 
fine needlework are exceedingly harmful for the eyes of a child. If, in spite 
of all these precautions, a visual weakness is suspected by the way in which 
the work is brought up close to the eyes, or by a lack of endurance, no time 
should be lost in providing for a careful examination by the physician. If 
deemed necessary, spectacles may be prescribed, so that the child may not 
be backward in school because of visual defects which can be remedied. 



















































325 


THE STANDARD FAMILY PHYSICIAN 


Eye 


A child who complains of a twitching of the eyeball, generally suffers from 
a congenital weakness, and allowances must be made for children thus 
affected. 

The beneficial effects which outdoor exercise, gymnastics, swimming, 
and other sports exert on the organism, are of course extended also to the 
organ of sight. But at the very beginning it is essential that any overin¬ 
dulgence in such sports be carefully avoided. Diving after objects is harm¬ 



ful because inflammatory disturbances may arise from keeping the eyes 
open under water for a prolonged time. 

The play of children should be under the supervision of either teachers 
or parents. Knives and other cutting instruments should not be permitted, 
and this restriction should be extended to weapons of all kinds, including 
the apparently harmless pop-guns and pea-shooters. Especial attention is 
here directed to the toy pistol; the explosion of the caps which are used in 
it often cause severe and incurable injuries to the eyes. 

The choice of an occupation should largely depend upon the condition 
of sight, and it is advisable to have this ascertained by a medical examina¬ 
tion. Where there is present a tendency to near-sightedness, no occupation 
should be chosen which requires distant vision as an essential. Those 
























Eye 


THE STANDARD FAMILY PHYSICIAN 


326 


afflicted with far-sightedness will, on the other hand, find it extremely incon¬ 
venient to follow a calling which requires the continued application of their 
sight to objects near at hand. If repeated inflammatory disturbances have 
brought about an irritable condition of the eyes, occupations must be avoided 
which necessitate exposure to external irritation, such as dust, smoke, strong 
light, or heat. The army, the navy, and the railroads have established cer¬ 
tain minimal visual requirements which must be fulfilled by applicants for 
positions in their service. 

The care of the eyes should not be neglected even by adults, who should 
always endeavor to alternate periods of work with rest, especially when 
doing work near at hand. When the time has arrived, usually about the 
forty-fifth year, when near vision becomes somewffiat impaired, the in¬ 
dividual should not hesitate to wear proper glasses in order to assist the 
eyes, instead of giving way to the popular delusion that such a course weakens 
the visual organs. The choice of glasses should not be left to the optician. 
Although apparently simple, this is a difficult task which requires exact 
study of each individual case, and the application of specialized medical 
knowledge. Reading while in the recumbent posture strains the eyes, and 
sewing at dusk or with insufficient light is also harmful and should be 
avoided. As a general rule it is well to avoid sudden changes of light and 
darkness, as well as a glaring light. The latter may be lessened by pro¬ 
tective spectacles or by white window-curtains. If the artificial light is too 
strong, some form of lamp-shade, or the protective eye-shade already re¬ 
ferred to, should be employed. The blinding which results from gazing into 
an open fire or into the sun is likewise harmful, and such exposure ought 
to be avoided. For the same reason, smoked glasses should be worn to 
overcome the blinding effects of sunlight on the snow, or when sojourning 
at the seashore. These glasses not only serve to protect weak, irritable 
eyes, but are of service also in protecting normal eyes which are exposed to 
various external irritants, such as bad air, and the entrance of foreign bodies. 
In case the latter accident has taken place, medical aid should be sum¬ 
moned. This applies particularly to cases where caustic substances, acids 
or alkalies, have penetrated the eye. Among foreign bodies must also 
be included the larvae of certain animals, which have entered the organism 
in contaminated food, and have then been taken up by the circulation and 
settled in the interior of the eye. Fortunately such cases are extremely 
rare. They constitute a serious condition, and can be eliminated only by 
operative procedures. 

The effects of various poisons may be very deleterious to the eye. The 
excessive use of stimulants, such as alcohol and tobacco, may cause symp¬ 
toms of visual disturbances; and poisons which enter the system in conse¬ 
quence of the individual’s occupation may likewise cause great harm. The 
latter condition is found among workers in bisulfid of carbon, many dyes, 








327 


THE STANDARD FAMILY PHYSICIAN 


Eye 


lead, etc. The best, and in fact the only efficient, treatment consists in the 
removal of the offending toxic material, and, where indicated, a change of 
occupation. 

The indiscriminate use of the various eye-washes commonly exploited 
calls for particular warning. They are either useless or harmful. Very 
often they are the means of postponing a timely consultation with the proper 
medical adviser. There are no drugs or salves which can strengthen the 
eyes. The treatment of such a delicate organ by household remedies, 
secret concoctions, or by a quack, usually meets with the reward which it 
deserves. Self-treatment with milk, raw meat, frog’s spawn, freshly passed 
urine, etc., can only be productive of harm to a diseased eye. But caution 
must not be limited to such disagreeable and disgusting remedies; it must 
be extended also to apparently harmless remedies, including cold applica¬ 
tions of water, camomile, and lead-water. In any given case the choice of 
the remedy should be left to the discretion of the physician, who also will 
decide whether cold, warm, or hot applications are to be employed. It is 
well to remember that in every case of disturbance which involves the eyes, 
the physician’s counsel had best be sought, for in no other organ of the body 
is it more difficult to compensate for the sins of omission. 

EYE, DISEASES OF.—The various diseases affecting the organ of sight 
may be conveniently discussed as external and internal, or those which 
affect the outer parts of the eye—the conjunctiva and the cornea; and those 
which have their seats in the interior of the eye—the choroid, the crystalline 
lens, the various media, the retina, and the optic nerve. These diseases are 
here discussed under their several headings. 

Conjunctivitis.—An inflammation of the conjunctiva, or the mucous 
membrane of the eyelid, and that portion of the mucous membrane of the 
eyeball which is united with the eyelid. It may be a simple catarrhal proc¬ 
ess—catarrhal conjunctivitis; a granular process—trachoma; or a purulent 
process—suppurative conjunctivitis or blennorrhea. 

Catarrhal Conjunctivitis is an extraordinarily frequent disease, met with 
in the larger cities. It is for the most part comparatively harmless, al¬ 
though not always so. As a rule it is due to external irritants, such as dust, 
smoke, and bad air, and manifests itself as a reddening of the eyelids, the 
profuse flow of tears, a burning pain, and some irritability of the eyes. \ ery 
often, on awakening in the morning, both lids will be found glued together, 
especially at the inner angle. In children, the inner surfaces of the lids 
often become the seats of small blisters as large as the head of a pin. The 
disease may not be the cause of any definite symptoms, and is sometimes 
discovered only by accident. 

Very often the condition may continue for years, and in obstinate cases 
it may resist every form of treatment. As a rule, however, the disease sub¬ 
sides under appropriate therapeutic measures. All secret remedies and 




Eye 


THE STANDARD FAMILY PHYSICIAN 


328 


eye-washes should be zealously avoided, as they are liable to do great harm. 
It is better to resort to timely medical advice. Ordinarily the introduction 
of eye-drops prescribed by the doctor, together with cooling applications, 

are sufficient. In obstinate cases 
it may be necessary to resort to 
mild cauterization of the mucous 
membranes of the eye. Sometimes 
the disease may be traced to some 
visual defect, such as near- or far¬ 
sightedness, or to an irregular curv¬ 
ature of the cornea. In such cases 
the wearing of suitable glasses will 
cause the trouble to disappear. 
Persons whose occupation exposes 
their eyes to continual irritation 
should wear a pair of protecting 
glasses (see Figs. 135, 136), and in 
some instances the abstention from 
smoking and drinking also has a 

Figs. 135 and 136. Protection glasses. P < 0 

very beneficial effect. 

Granular Conjunctivitis is a contagious disease which runs a chronic 
course with occasional exacerbations. It appears as a violent inflamma¬ 
tion of the mucous membranes of the eye, which become covered with numer¬ 
ous, oval, transparent nodules (see Plate XII. Fig. 4). The severity of 
the disease depends in the first place upon its chronic course, and secondly 
upon the complications and sequelae. When the disease has been present 
for some time, cloudiness and ulceration of the cornea may develop, re¬ 
sulting in the more or less complete loss of sight. This may be accompanied 
also by a scar-like contraction of the connective tissue of the lids, adhesion 
between the latter and the eyeball, and inversion of the eyelids and the eye¬ 
lashes. During its entire course the disease is marked by the discharge of 
more or less mucus and pus, by pain, and by a morbid intolerance of light 
( photophobia ). The severity of these symptoms depends upon the extent 
to which the cornea has been involved. 

This form of conjunctivitis is usually met with among the unclean, 
poorly domiciled lower classes; and is found also in institutions, where its 
spread is favored by the use in common of towels and other objects. Cer¬ 
tain localities (such as Arabia and Egypt) are especially afflicted; and in 
eastern Europe (Russia, Poland, Hungary) the disease is more prevalent 
than in the western part of the continent. In low countries (as Holland 
and Belgium) the disease is of more frequent occurrence than in mountain¬ 
ous countries like Switzerland. The disease, which has been endemic in 
Europe from the earliest times, became epidemic in that continent after 







329 


THE STANDARD FAMILY PHYSICIAN 


Eye 


the return of Napoleon I. from his Egyptian campaign. At that time hun¬ 
dreds of thousands were afflicted; but since then the virulence has declined, 
although it is to be noted that lately it has again extended itself in Prussia. 
The disease is being brought to the United States through the great arteries 
of immigration, although attempts—more or less successful—are being 
made to prevent its entrance. 

The main essentials for patients suffering from granular conjunctivitis 
are cleanliness, fresh air, and clean clothes. In order to prevent the in¬ 
fection of others, patients should have their own toilet-articles, particularly 
towels. At the earliest symptoms of infection, cooling applications and lo¬ 
tions are indicated, which may be followed later by cauterization of the con¬ 
junctiva with nitrate of silver or sulfate of copper. In obstinate cases it may 
be found necessary to resort to an operation by which the nodules should be 
removed as rapidly and completely as possible. The troublesome inversion 
of the lids can likewise be corrected only by operative means. 

Purulent Conjunctivitis is an acute conjunctivitis with the formation 
of serum, fibrin, and pus. It is most frequent in the new-born. A sup¬ 
purative inflammation of the mucous membrane of the eye in the new-born 
infant results from an infection by secretions which are present in the geni¬ 
tal passages of the mother, and it can usually be proved that the latter had 
been afflicted with a gonorrheal discharge. The conjunctivitis begins, two 
or three days after birth, with a profuse, thick, yellow, purulent discharge, 
and a swelling of the mucous membrane of the eyelids. For preventing the 
disease, the method devised by Crede is now almost universally employed 
(see Eye, Care of). If a purulent discharge is observed even after the 
use of this treatment, medical aid should at once be sought. Very often 
it is possible to save the eye, although it may require weeks of earnest and 
devoted attention. The condition must be looked upon as an extremely 
dangerous one, and any prediction regarding its course must be made with 
caution. In very severe cases the process may go on to ulceration of the 
cornea and complete loss of sight. About ten per cent, of all cases of blind¬ 
ness due to inflammation are usually found to have occurred in children 
who were not given the benefit of medical treatment, or who received such 

treatment at a late stage of the disease. 

In adults the disease may be caused by accidental inoculation or by lack 
of cleanliness, where a gonorrheal discharge from the urethra is present. 
As a general rule, the course of the disease in adults is even more virulent 
than in new-born infants. The disease manifests itseli, within twelve 
hours after infection, by the excretion of a profuse purulent discharge, which 
is at first watery and later creamy, and also by an intense swelling of the 
lining mucous membranes. Here, as in the infantile type, the danger lies 
in the formation of corneal ulcers, and the prognosis depends upon the 
amount of swelling of the conjunctiva and upon the time at which tin 




Eye 


THE STANDARD FAMILY PHYSICIAN 


330 


patient comes under treatment. If no complications occur, the disease lasts 
about three weeks in children, and six in adults. It is advisable for adult 
patients to go to a hospital or sanitarium if possible, on account of the 
numerous chances which they offer of infecting their surroundings. The 
affected eye must be irrigated every hour or even every few minutes, day 
and night, a task which had best be assigned to a skilled nurse. The 
eyelids are separated with the second and third fingers of the left hand; as 
much of the secretion as possible is removed by gentle manipulations 
toward the inner angle of the eye; and irrigation is done with a wad of 



Fig. 137. Watch-glass held in place by adhesive plaster, to protect the eye. 

cotton saturated with the prescribed solution or with boiled water, and held 
between the fingers of the right hand. The cotton swabs should be 
burned immediately after use. 

The healthy eye should be covered with a contrivance consisting of a 
watch-glass held in place by adhesive plaster (see Fig. 137) in order to pro¬ 
tect it from the purulent infectious secretion. Ice poultices, kept on con¬ 
tinuously day and night, are very efficacious, but they must never be placed 
directly on the lids, a protecting compress made of several folds of a thin 
handkerchief being interposed between them. The necessary medicinal 
treatment can be undertaken only by the physician or by a specialist. Every 
patient afflicted with a gonorrheal discharge should be cautioned to prac¬ 
tise extreme cleanliness, and should be informed of the dangers attendant 
upon infection of the eyes. 

Diseases of the Cornea.—Acute affections of the cornea are always ac¬ 
companied with marked redness of the eyes, with pains, photophobia, and 















331 


THE STANDARD FAMILY PHYSICIAN 


Eye 


secretion of tears. A characteristic sign of an inflammation of the cornea 
is the appearance of a sharply defined or more extended cloudiness of this 
otherwise transparent membrane. The otherwise reflecting surface of the 
cornea becomes opaque and uneven, or smooth, according to whether the 
affection is situated in its more superficial layers, or in its deeper ones. 

Superficial Inflammation of the Cornea is a very frequent disease in small 
children; generally as a symptom of scrofula. It shows a great tendency 
to recurrence. On healing, more or less dense scars ( corneal opacities) 
are left, which may give rise to considerable disturbance of vision, espe¬ 
cially when they are situated in the center of the cornea. If the affection per¬ 
sists for some time, ulceration may ensue; and in particularly obstinate cases 
this may lead to perforation of the cornea, escape of the aqueous humor, 
and prolapse of the iris. Ulcers of the cornea may arise also after super¬ 
ficial injuries; frequently they spread very rapidly (especially when occur¬ 
ring simultaneously with an affection of the lacrimal sac), and they heal but 
slowly and with the formation of dense scars. 

Deep-seated Inflammation of the Cornea ( Keratitis) is an affection which 
runs a very protracted course. As a rule both eyes are involved simul¬ 
taneously; sometimes one following the other after a longer or shorter in¬ 
terval. In most instances inherited syphilis is the cause of the disease, 
although it may arise also from a neglected chronic catarrhal conjunctivitis. 
The younger the patient, the more favorable, as a rule, is the course of the 
affection. Deep-seated opacities usually persist. 

Purulent Inflammation of the Cornea occurs most frequently as a result 
of injuries. If the pus accumulates in the anterior chamber of the eye, it 
will in most cases be found necessary to remove it by an operation. 

Injuries and Wounds of the Cornea , which may be caused by the entrance 
of foreign bodies or by violence, etc., should always receive the immediate 
care of a physician in order that grave complications may be avoided. The 
same applies to erosions by chemicals, etc. 

Buphthalmia or Ox-Eye is a congenital affection of the cornea (see 
Plate XII. Fig. 2) which is characterized by an excessive collection of aque¬ 
ous humor, causing all parts of the eyeball to bulge. The cornea is 
sometimes clear, but as a rule slightly opaque. Blindness is certain to 
follow, if operation, which consists in the excision of part of the iris, is 
delayed. 

Treatment of affections of the cornea should always be left to an oph¬ 
thalmologist, owing to the diversity of the symptoms. In general it may 
be said that hot compresses are better borne than cold ones. Warning 
should be given against the indiscriminate application of eye-waters, as v eil 
as against the inappropriate massage of the eye by which many quacks have 
caused blindness in cases in which it would otherwise have been possible 

to save the eye. 




Eye 


THE STANDARD FAMILY PHYSICIAN 


332 


Choroiditis.—Inflammation of the choroid coat of the eyeball; a dis¬ 
ease which may occur at any time of life. Beginning as an inflammation 
without pain or outward evidences of its presence, it leads gradually to an 
impairment of vision, due to the involvement of the retina and the vitreous 
body. The patients notice that they see badly when the evening twilight 
comes on, that there are blanks in the visual field, and that objects appear 
distorted. There are also various light disturbances, such as flickering be¬ 
fore the eyes, sparks, points of fire, etc. This disease, which can be recog¬ 
nized only by aid of the optical mirror (ophthalmoscope), pursues a very 
insidious course. As it progresses, complete blindness may result. The prin¬ 
cipal causes are syphilis and tuberculosis, and, aside from these, general nutri¬ 
tive disturbances, anemia, scrofula, etc. The best results from treatment 
are obtained in the syphilitic cases. 

Inflammation of the Iris.—A comparatively severe affection which 
usually occurs in consequence of a general disease, most frequently of syph¬ 
ilis. It may occur also as a part symptom of diabetes mellitus, gonorrhea, 
or rheumatism. The disease manifests itself by redness of the eye, by 
dread of light, and by violent pains radiating into the forehead. Medical 
treatment is necessary without delay, as otherwise adhesions and other 
disturbing conditions develop which may give rise to considerable impair¬ 
ment of sight, or even to Glaucoma and consequent loss of vision. The 
physician will treat the local condition as well as the general health, thus 
guarding against recurrences. Resting the eyes is an essential requirement, 
and it is advisable to wear dark-colored glasses. 

Diseases of the Retina.—Affections of the inner coat of the eye, like 
those of the optic nerve, are recognizable only by means of the ophthalmo¬ 
scope. As a rule they are painless, except when the disturbance has reached 
an advanced stage. 

Inflammation of the Retina usually manifests itself in a bloodshot con¬ 
dition of this membrane, and is almost invariably a sign of some general dis¬ 
ease, such as syphilis, inflammation of the kidneys, diabetes, heart-disease, 
or arteriosclerosis. Anything that improves the general health will usually 
help the eyes at the same time. Chronic inflammations lead to irrecover¬ 
able blindness. 

Separation of the Retina is usually the outcome of a very intense form of 
near-sightedness, and is always a serious matter, even though it is some¬ 
times possible to prevent it from causing blindness. It may arise also from 
a tumor of the inner eye, and in such cases it is necessary to remove the 
affected eye immediately, on account of its menace to life. 

A deposit of pigment in the retina may occur as a symptom of hered¬ 
itary syphilis, or as a consequence of blood-relationship in parents, and 
occasionally without any determinable cause. These troubles lead slowly 
but surely to blindness. 





333 


THE STANDARD FAMILY PHYSICIAN 


Eye 


Diseases of the Optic Nerve.—Injury or disease of the optic nerve results 
in acute or gradual blindness. Sudden hemorrhage into the retina, and 
acute poisoning from wood-alcohol, lead, quinin, and other substances, re¬ 
sult in transitory or in permanent blindness. The pressure of a tumor 
within the brain affects the optic nerve, and if the pressure continues for any 
great length of time it usually induces blindness. Gradually increasing 
blindness may be due to a number of other causes, all of which require 
expert diagnosis. 

See also the articles Amaurosis; Amblyopia; Blindness; Glaucoma; 
Hemeralopia; Nyctalopia; Scotoma; Sight, Disturbances of; 
Squinting. 

EYE, INJURIES TO .—Lesions resulting from external violence to the 
organ of sight must always be considered very serious. They demand im¬ 
mediate medical attention, and preferably that of a specialist. Even slight 
outward evidences of injury, such as discoloration of the eyeball by blood, 
may mean laceration of the membranes in the interior of the eye and hem¬ 
orrhage into the vitreous body. An important point in the prognosis de¬ 
pends on whether or not the injury has resulted in opening the eyeball and 
establishing a communication between the interior of the eye and the ex¬ 
ternal air. Where this has not occurred, as in contusions and concussions, 
healing takes place rapidly; whereas in the other case there is usually loss 
of sight and destruction of the entire eye. The severe character of such 
an-injury is due to the fact that objects which penetrate the eye are usually 
unclean, and thus bring about suppuration. The contraction of the eyeball 
results in gradual loss of vision. Moreover, it often happens that the sur¬ 
geon is compelled to enucleate the affected organ when it is found impos¬ 
sible to check the inflammation, and prevent it from involving the healthy 
eye. 

The treatment of injuries to the eye should usually be left entirely to 
the physician, and while waiting for his arrival the eye should merely be 
covered with a clean handkerchief. Simple contusions may be treated 
by the application of cold compresses. Where the injury is due to the en¬ 
trance of chlorid of lime, as many of the particles as possible should be re¬ 
moved by irrigation with water, milk, or oil, and also by gently wiping out 
the conjunctival sac. Foreign bodies, such as bits of coal and steel, are 
usually to be found on the inner surface of one of the lids, more frequently 
the upper, or they are embedded in the cornea. The patient will but rarely 
succeed in removing them by stroking the eye in a direction from the temple 
toward the nose, or by wiping the cornea with the lid everted. If the rub¬ 
bing is done too forcibly, the foreign body becomes embedded more firmly 
in the eye, the irritation increases, and the pain grows more severe. In such 
a case it is better to protect the eye with a clean cloth and allow the offend¬ 
ing body to be removed by a physician. The manner in which the upper 




Eye 

Eyelids 


THE STANDARD FAMILY PHYSICIAN 


334 


lid may be everted for the purpose of exposing the foreign body, is shown 
in Plate XII. Fig. i. Even after the removal of the foreign object the sen¬ 
sation caused by its presence persists for a time. Steel splinters which 
have become lodged in the vitreous body, or in other deep parts of the eye, 
must be extracted with a magnet devised for this purpose. 

EYE, INSTILLATIONS INTO.—Eye-drops may be instilled into the eye 
by aid of a glass rod, or better with an eye-dropper. The latter consists 
of a glass tube pointed at one end, and furnished with a rubber bulb at 



the other (see Fig. 138). A contrivance of this kind is fitted into the 
stopper of the bottle which contains the medicine to be used. The eye¬ 
dropper is filled by squeezing the rubber bulb between the fingers, then 
dipping the end of the tube into the prescribed fluid, and releasing the pres¬ 
sure of the fingers. The dropper is then held over the inner angle of the 
eye, and by pressing the two fingers together on the rubber bulb a few drops 
are instilled into the eye which is held open with the thumb and index-finger 
of the other hand. This distributes the fluid over the interior of the eye, 
and the burning sensation ordinarily disappears within a few minutes. The 
instillation may be followed by the application of a cold compress for a time. 
If the excretion from the eye is very profuse, it is necessary to clean the eye 
by irrigations and thorough drying before the drops are instilled. 

EYELASHES, AFFECTIONS OF.—Eyelashes are fine, small hairs, dark 
or light in color, which grow in two or three rows along the edge of the eye¬ 
lid. They belong to the protective organs of the eye, serving to guard it 
from dust, from the entrance of foreign bodies, and particularly (like the 
eyebrows) from the drops of perspiration which run down from the fore¬ 
head. The roots of the eyelashes frequently become the seat of an inflam¬ 
mation which, if neglected, will cause the hairs to fall out. This not only 
mars a person’s appearance, but leaves the eyes without lashes, which 
makes them irritable and sensitive to the light. When the eyelids turn in T 
ward on account of inflammation, the lashes rub against the sensitive cornea 
and cause severe chafing every time the eyelids close. Eyelashes may grow 
in a wrong direction even when there is no inflammatory condition of the 
lids. When this is the case they must be pulled out, and if they continue 
to grow they can be eradicated by electricity. 

EYELIDS, BLINKING OF.—The purpose of blinking is to distribute 
over the surface of the eye the moisture which is derived from the conjunc¬ 
tiva and the tear-glands, and thus to prevent the cornea from becoming dry. 
Whenever the eye is irritated, this blinking is increased. In children this 
is often attributed to bad habits, but it is more apt to be due to some 










335 


THE STANDARD FAMILY PHYSICIAN 


Eye 

Eyelids 


catarrhal condition of the conjunctiva or to a deviation from normal vision, 
either near-sightedness or far-sightedness. In severe cases a muscular spasm 
of the lids may actually be present, and this is often a very obstinate condi¬ 
tion, which improves only after prolonged treatment with electricity, or after 
stretching and exercise of the affected muscles. 

EYELIDS, DISEASES OF.—The eyelids may be affected with diseases 
similar to those which involve other parts of the skin; for instance erup¬ 
tions, erysipelas, formation of blisters, suppurations, furuncles, carbuncles, 
various forms of benign and malignant ulcers, warts, encysted tumors, dil¬ 
atations of vessels, etc. Dark-yellowish spots of various sizes are very 
frequent. These affections are all treated according to the usual principles. 

Swelling of the eyelids is always a symptom of disease, possibly of sup¬ 
puration of the eyelid, of a sty, of an affection of the lacrimal sac, of deep- 
seated disorders of the eyes, or of a disease of the kidneys. Extravasations 
of blood into the lids occur after injuries to the eyelids or to more remote 
parts; for instance, after a fracture of the skull or of a wall of the orbit. 

The borders of the eyelids are also the seat of frequent affections and in¬ 
flammations. Scales, small ulcers, and crusts may develop here, causing 
the lashes to become matted. If these conditions persist for some length 
of time, the skin of the eyelids becomes affected, and scar-tissue develops 
which turns the borders of the lids inside out. This causes a condition 
known as blear-eye, which is as unsightly as it is annoying. A sty gener¬ 
ally develops on the border of the lid, whereas an internal sty represents a 
slowly growing tumor located in the lid itself. 

Eversion of the eyelid (blear-eye) occurs also in inflammation of the 
lids, and likewise as a consequence of scar-forming injuries to the skin of 
the lids; it may appear also as a symptom of old age. Inversion of the eye¬ 
lids takes place in various inflammatory affections of the eye, especially 
in granular lids, or trachoma. This condition is aggravated by the friction 
of the inverted lashes upon the cornea. See Eyelashes, Affections of. 

Imperfect closure of the eyelids (hare’s eye) is due to shortening of the 
lids owing to chronic inflammation, to paralysis of the nerve which supplies 
the lid-closing muscle, to exophthalmic goiter, or to protrusion of the eye¬ 
balls as a result of tumor formation. When very marked, this condition is 
dangerous because the cornea, which is not covered by the lid during sleep, 
is liable to become dry and ulcerated. Like all the other changes in the 
position of the eyelids, this condition can be cured only by operation. 

Drooping of the eyelids is very rarely congenital, but is most frequently the 
result of injuries, tumors of the lids, inflammations, or paralyses of nerves. 

Spasms of the lids occur either as twitchings (winking), or very often 
as convulsive closing of the lids in scrofulous eye-affections of children. 
The operative widening of the opening between the lids, an absolutely 
harmless operation, often gives surprisingly good results. 





Face 


THE STANDARD FAMILY PHYSICIAN 


336 


F 

FACE, DISEASES OF.—A number of affections may be localized in the 
facial region. These may involve the sensory nerves, giving rise to pain, 
facial neuralgias, etc., chief of which are those due to defective teeth; or they 
may involve the facial motor nerves, causing facial spasms (tics), or facial 
paralysis (Bell’s Palsy), or wasting of the muscles of the face. The nerves 
chiefly involved are the fifth, causing sensory symptoms, and the seventh, 
affections of which cause the motor symptoms, the paralyses. The spasms, 
or tics, are probably of cerebral origin. 

Atrophy of the Face.—A rare affection which is characterized by a wasting 
of one side of the face. It is due to a severe injury to the nerve, and mani¬ 
fests itself by a slow and gradual wasting, first of the skin, then of the fatty 
tissue, and finally of the bone. This causes the affected half of the face to 
fall in (see Plate XVIII., 4). The disease occurs most frequently during 
youth and in the female sex. A retrogression of the symptoms is very rare. 
Apart from a slight inconvenience in chewing, there is little to disturb the 
patient’s health. The progress of the disease ceases, as a rule, when it has 
reached a certain development, and thus the distortion of the face does not 
go on indefinitely. The lesion is usually in the medullary centers. 

Pains of the Face.—These occur frequently in the region of the tri¬ 
geminal nerve as the result of injuries, exposure to cold, or bodily disease 
(such as typhoid, influenza, or gout). Affections of the nose, ear, and 
particularly of the teeth may also be factors. The nerve-branches most 
frequently affected are the superior and inferior orbital nerves—causing 
headaches in the regions of the forehead and eye, and those nerves which 
supply the region of the lower jaw—causing toothache. The most severe 
form, which is especially designated as “tic-douloureux,” 'is the excrucia¬ 
ting, twitching pain which appears in lightning-like flashes in two or three 
places, mostly confined to one half of the head. At the onset of this latter 
affection it is possible to effect a cure by systematic stretching of the skin 
and muscles, and by other methods to be determined upon by the physician. 
Severe and chronic cases must be treated by surgical measures, injections of 
osmic acid, nerve cutting, or by destruction or removal of the Gasserian 
ganglion. 

Patients suffering from facial pains should consult their physician as to 
the treatment, and should beware of the numerous, greatly extolled “head¬ 
ache” and “pain-killing” remedies, such as antipyrin, acetanilid, phenace- 
tin, orangein, migrainin, etc.; and they should especially avoid the use of 
opium in any form. 

Paralysis of the Face.—This condition is brought about by injury to 
the seventh, or facial nerve, which controls the movement of various facial 




337 


THE STANDARD FAMILY PHYSICIAN 


Face 


muscles, such as those of the forehead, eyelids, cheeks, lips, and chin. If 
the nerve be disordered or destroyed, the result will be partial or complete 
paralysis of that half of the face which is supplied by the affected nerve. 
As a rule the affection is not painful. In case of a complete paralysis of one 
side of the face, the patient presents the following appearance (see Plate 
XVIII., 2): One side of the face appears distorted, and strange to say 
the abnormality seems to the non-medical mind to be situated in the well 
side of the face and not in the affected part. When speaking, the patient 
moves only the healthy half of the face, the paralyzed side remaining flac¬ 
cid, rigid, or quiet. The normal facial wrinkles and folds show on the 
unaffected part of the face, but have disappeared on the diseased part. 
The corner of the mouth droops, and owing to the paralysis of the 
muscles of the lips and cheek the patient is unable to pucker his lips, to 
whistle, and to knit his brows. It often happens that he is unable to close 
the eye of the affected side, and that he bites the mucous membrane of the 
cheek when he eats. 

The cause of the paralysis is either an internal one (an apoplectic stroke), 
in which case other parts of the body may be involved; or it is an external 
one, such as exposure to constant draft, or injury to the nerve itself. The 
patient may, for instance, have exposed one side of his face to a draft of 
cold air by sitting for hours in a railroad train by an open window. Facial 
paralysis following an apoplectic stroke is usually very persistent. Serious 
damage to the brain-tissue has occurred, and is not readily overcome. Only 
in the most favorable cases is it possible to achieve a certain degree of im¬ 
provement in the course of time and with proper treatment. Paralyses due 
to involvement of the nerve itself, as those following exposure to cold, run 
a more favorable course. The mildest forms of paralysis of this nature may 
be cured in a few weeks or months under proper medical treatment; in the 
severer cases it takes several months to effect a cure. In those rare in¬ 
stances where the cause is other than a simple exposure to cold, it may be 
impossible to effect recovery. The paralyses due to diseases of the ear 
are frequently of this nature. 

The treatment for paralyses due to internal causes includes the appli¬ 
cation of electricity to the affected part, massage, sweating-baths, and packs. 
Where an apoplectic stroke is the cause, the treatment consists in icgula- 
tion of the mode of living, rest, and internal medicines, lecent cases may 
be benefited by the application of ice or cold compiesses to the head, and 
by bloodletting. Rubbing the affected half of the face with alcohol stimu¬ 
lates the skin and promotes the circulation of the blooel. The much-\ aunteel, 
so-called “apoplectic waters” are humbugs. The sufferer should learn to 

acquire patience. 

Spasm of the Face. —In the faces of many persons, especially under the 
eyes, there is often observed a rapid, periodical twitching of the muscles. 






.Fainting- 

Fang-o 


THE STANDARD FAMILY PHYSICIAN 


S38 


The affection is designated as a convulsive tic It may involve also other 
muscles, sometimes causing peculiar facial grimaces. It is not a painful 
affliction, but is disturbing and inconvenient. These spasms may occur 
on one or both sides of the face, and are caused by affections of either the 
jaws, the eyes, or the ears. Painful diseases of the teeth, paroxysmal pains 
of the face, as well as a number of nervous diseases, such as hysteria, and St. 
Vitus’s dance, may give rise to the “making of faces.” A frequent form 
of facial spasm is “winking” of the eyes. 

Electricity, almost the only remedy employed in the treatment of this 
disorder, does not give as certain and rapid relief as repeated stretching 
and massage of the affected muscles. Pure nervousness or fatigue may be 
the cause of many of these tics, and in such cases rest and food are fre¬ 
quently sufficient to bring about relief. The movements are often self- 
induced, and these are among the most difficult to cure. The patients get 
into a bad “habit,” and the convulsive movements, at first voluntary and 
readily controllable, gradually become almost beyond the control of the 
patient. 

FAINTING.—A sudden slight loss of consciousness brought about by a 
diminution of the amount of blood supplied to the brain. It is of frequent 

occurrence, and may be occasioned 
by violent pain, marked psychic 
emotions, bodily overexertions, 
great losses of blood, or even by 
staying for some time in an over¬ 
crowded room. It is characterized 
by dizziness, ringing of the ears, 
inability to recognize surrounding 
objects (which appear to revolve), 
cold perspiration, deathly pallor of 
the face and lips, and sudden col¬ 
lapse. The limbs are fully relaxed, 
respiration is scarcely noticeable, 
and the pulse can hardly be felt. 
Sometimes this condition may pass 
off in a few seconds, but in other 
cases it may persist for several min¬ 
utes. 

To treat such attacks, the pa¬ 
tient’s head should be lowered, all 
constricting garments loosened, and 
cold water dashed upon his face and 
chest. Smelling-salts or cologne are useful as stimulants applied to the nos¬ 
trils, but it is still better to leave the patient alone with plenty of fresh air and 
















THE STANDARD FAMILY PHYSICIAN Fango ng 

resting comfortably with the head on a pillow. As soon as the patient is 
able to swallow, coffee, tea, or a mild alcoholic stimulant may be adminis¬ 
tered. The method of leading a person who is in a fainting condition is 
illustrated in Fig. 139. 

FALLOPIAN TUBES, DISEASES OF.— See Ovarian Tubes. 

FANGO. A volcanic mud of clay-like appearance, found in northern 
Italy. It is used for packs and poultices. The patient is placed upon a 



Fig. 140. Application of fango. 

woolen blanket spread over a waterproof sheet, and the mud, which has 
been heated to 104 F., is spread upon the affected parts of the body in a 
layer of about half an inch in thickness (see Fig. 140). The rest of the body 
is either covered lightly or, if the general effect is to be intensified, is wrapped 
in several blankets so that the patient perspires freely. The duration of a 
fango-pack varies from 30 minutes to one and one-half hours. Upon the 
removal of the mud, the patient is placed in a lukewarm bath for about five 
minutes, and finally treated with a cool shower-bath. He then rests for 
some time upon a couch. 

It is obvious that the mud of itself has no physiological action, but it sup¬ 
plies a uniform, moist heat which is retained for a long time. The method, 
therefore, is merely a substitute for the old-fashioned linseed and water 
poultices, steam compresses, hot poultices of mud, sand-baths, etc. It is 
employed in the treatment of persistent joint-affections, in gout, articular 
and muscular rheumatism, and for neuralgias in general. 























S™if htedlie3s THE STANDARD FAMILY PHYSICIAN 


340 


FAR-SIGHTEDNESS (PRESBYOPIA) .—See Sight, Disturbances of. 

FAVUS.— A parasitic disease of the skin, affecting chiefly the hairy parts 
of the scalp, and being due to a fungoid growth. It is characterized by the 
appearance of flat, yellowish crusts which adhere tightly to the skin, each 
of them being transfixed by a hair. After the disease has existed for a time, 
considerable areas may be covered by a thick, scaling crust; but the scalp 
is never entirely involved, and that portion which includes the temples and 
the occipital region may remain altogether free. The hair loses its gloss, 
and appears as if covered with a fine dust. Patients afflicted with this dis¬ 
ease give rise to an odor resembling that of mice. After a time the scales 
fall off and with them the affected hairs, leaving smooth, white, hairless 
scars. A spontaneous cure may result in from twenty to thirty years, be¬ 
cause by that time all the diseased hairs have disappeared, and the fungus 
can develop only along a hair or its sac. Transmission can take place from 
one human being to another, or the disease may be derived from dogs, 
cats, rabbits, mice, rats, or poultry. Treatment consists in the removal of 
the scales with soap and water, disinfection of the diseased area with 
salves, and pulling out the affected hairs. Medical aid and direction is 
necessary. 

FEAR. —In many cases of illness there are present certain very annoy¬ 
ing conditions of fear and apprehension. They are often due to insufficient 
nourishment of the brain, and are seen in a marked degree in melancholia, 
insanity, and other mental disturbances, and also in cases of cerebral poi¬ 
soning by alcohol or tobacco. The state of fear associated with high fever 
also belongs in this category, and is partly due to toxic materials circulating 
in the blood. A fear of death, accompanied by a cold, clammy perspira¬ 
tion, is often observed in the advent of sudden cardiac failure, as from in¬ 
ternal hemorrhage, as long as consciousness remains. In the presence of 
cardiac disease or calcification of the coronary arteries, attacks of fear often 
occur, combined with a feeling of impending death; but these are usually 
transitory. 

A distinct train of symptoms is furnished by the frequent attacks of 
fear in neurasthenics. This comes on after severe exertion, mental excite¬ 
ment, the use of stimulants, sexual excesses, etc. Very often a hereditary 
predisposition is present. In these neurasthenic attacks, the patient’s heart 
begins to beat very rapidly, and he is seized with a sudden intense fear; 
under certain conditions he may be prompted to do the most ridiculous 
things. The attacks may be induced by a variety of circumstances; for 
example, by being seized with vertigo in an elevated locality, such as a 
mountain, a tower, a bridge, or even at an open window. A state of fear 
may also be generated in such persons when they are compelled to walk 
across a large square or along a long row of houses; and under this category 
may also be classed those cases of fear which are occasioned by staying in 









341 


THE STANDARD FAMILY PHYSICIAN 


Far-sightedness 

Fennel 


a closed room, in a church or theater, in the presence of other persons, or 
before an audience (the “stage fright” of actors, lawyers, and preachers). 

The morbid fear of contracting every serious form of disease is usually 
due to improper reading or conversation. Another form of phobia is that 
of becoming soiled by contact with persons and ordinary objects. Such 
persons refuse to shake hands, permit no one to come into their rooms or 
dwellings, keep by themselves, and wash their hands many times daily. 
These morbid thoughts also take on a religious aspect, and afflicted indi¬ 
viduals are made to believe that the contact or even the glance of another 
person will contaminate their souls and render them sinful. A condition 
of this kind is exemplified by the ascetics, and other religious bodies of 
the middle ages, who in the light of present-day knowledge must be looked 
upon as mentally defective persons. Many of these cases are curable, and 
much can be accomplished by rest of the body and mind, together 
with appropriate tonics and attention to the primary cause of the trouble. 
See Dubois, The Psychic Treatment oj Nervous Disorders , New York, 
i9 °5. 

FECAL VOMITING. —A very annoying as well as sinister symptom, 
which occurs as a result of the narrowing or occlusion of the intestinal canal 
in any part of its length (for instance, in incarcerated hernia). The excre¬ 
ments situated above the obstacle, not being able to find their natural exit 
downward, are passed into the stomach by retrograde movements of the 
intestine, and are vomited from the stomach. Vomiting of a truly fecal 
character takes place only when the intestine is obstructed in its lower por¬ 
tions, as the upper portions of the bowel (duodenum and jejunum) do not 
contain any formed excrements. Fecal vomiting is always a grave symptom, 
and requires immediate surgical treatment. 

FEET, PERSPIRATION OF.— See Skin, Care of. 

FEL BO VIS (OX-GALL).— The fresh bile of the ox, Bos taurus. It 
has only recently been introduced into medicine as a stimulant to the biliary 
secretions. Ox-gall, either in the form of enemas or of pills, is of service 
in chronic constipation and obstipation due to insufficient activity of the 
liver. It is given in doses of about five grains. 

FELON. —See Runround. 

FENCING.— An excellent form of exercise which has been practised by 
man ever since he has had weapons. The practise is in vogue at the present 
day, and the weapons used are either foil or broadsword. Owing to the 
requirements of dexterity, of reliability of sight, and of strength of aim, it 
may be recommended to healthy persons of younger years. If the \arious 
cuts and thrusts are executed, not merely against a wooden manikin, but 
against an actual opponent, it is necessary to protect the head and bod} by 

masks and plastrons. 

FENNEL.— See Fceniculum. 




.Ferments 

Fever 


THE STANDARD FAMILY PHYSICIAN 


342 


FERMENTS. —Substances that act in some unknown manner on other 
substances, bringing about chemical changes, and yet not themselves enter¬ 
ing into the reaction, have been termed ferments, or enzymes. Both inor¬ 
ganic and organic ferments are known. Platinum black, manganese, and 
other metals, in finely powdered forms, are known to show the character¬ 
istics of ferment action. The most important of the ferments, however, are 
of organic origin, and may be either of animal or of plant manufacture. 
The digestive ferments pepsin and trypsin , from the stomach and pancreas 
respectively, play an important role in the breaking down of proteid foods; 
while the ptyalin of the saliva and the amylopsin of the pancreas act on 
carbohydrates, rendering them capable of absorption into the lymphatics. 
Steapsin is another pancreatic ferment, and is indispensable in the digestion 
of fats. Other ferments are known in the human body, such as thrombin , 
or the fibrin ferment, the enzyme which causes the blood to clot. Oxidiz¬ 
ing ferments are known that behave in a manner similar to laccase of Jap¬ 
anese shellac. The body probably contains many important ferment-like 
substances, which are not yet known. 

Of the organized ferments, the yeast and bacteria plants are of particular 
interest, the former especially on account of their property of breaking down 
sugars to form alcohol, carbonic acid, and water. The bacteria also show 
marked ferment action. Many of them set free a clotting ferment, as is 
seen in the clotting of milk, where an action takes place corresponding to 
the coagulation of the blood. A similar action is exerted by rennet on milk. 
The formation of plant jellies is caused by a similar clotting ferment—- 
pectase. The study of the ferments and of fermentation is as vet only in 
its infancy. 

FERRUM. — See Iron. 

FETUS. —See Parturition. 

FEVER. —A rise of the temperature of the body above the normal, 
which is 98.6° F. (99 0 F. by rectum). It is, as a rule, a symptom of the 
body’s reaction to some form of infection, and, like pain, it should not be 
regarded as a disease of itself, but as an indication of a disturbance in the 
heat-regulating apparatus, due to infection or poisoning. For this reason 
physicians do not lay the principal stress upon the reduction or removal of 
the fever, prominent and alarming though it may appear to the laity; but 
they devote their chief attention to the underlying cause. The patient would 
be benefited but little if, for instance, no notice was taken of the severe intes¬ 
tinal disturbance in typhoid fever, or to the focus of inflammation which en¬ 
dangers life in pneumonia, and attention paid only to the reduction of the 
temperature. 

It may be questionable whether the treatment of fever is ever iustified 
without special reasons. I hat is to say, there are many indications which 
point to the fact that fever is one of the body’s methods of self-defence in its 






343 


THE STANDARD FAMILY PHYSICIAN 


Ferments 

Fever 


struggle against the germs that have invaded it. Several investigators have 
been able to prove beyond a doubt, that many varieties of bacteria experi¬ 
ence a weakening of their vital energy and strength at a temperature of 
99.5° F., so that they can no longer exert as destructive an activity in the 
body they have invaded. In many acute infections, such as pneumonia, 
for instance, the disease begins with a violent chill. This is due to the fact 
that the smallest vessels of the skin contract at the onset of fever, thereby 
causing an accumulation of blood in the interior of the body, and thus rais¬ 
ing the temperature. This accumulated heat is thrown forward to meet 
the enemy, as it were, and if possible to kill off the invading micro-organ¬ 
isms. The increase in the temperature of the body is therefore due, in the 
first place to a diminished expenditure of heat, and secondly to an increased 
formation of heat. 

The degree of fever to be considered is difficult to establish. Age and 
sex, motion and rest, morning and evening, exert some influence upon the 
temperature of the body. Even in conditions of complete health, high 
temperature may result from bodily exertion, from abundant eating, or 
from hot baths. A temperature which is entirely without significance in a 
strong child may cause serious considerations in the case of a debilitated 
or aged person. The classification of fever temperatures can therefore at 
most be considered of only a general value, subject to special laws in each 
individual case. Temperatures of 99.5 0 to 100.5° F. are considered as mild 
elevations; 100.5 0 to 101.5 0 F. as slight fever; up to 103° F. as moderate 
fever; up to 105° F. as considerable fever; and temperatures above 105° F. 
as high fever. Disregarding exceptional cases (for instance, 122 0 F. ob¬ 
served in a case of injury to the spinal column), the highest temperature 
within the limit of life is, on an average, 107.6° to 108.5 0 F. But, as stated, 
a patient’s temperature alone will give no absolute indication as to his con¬ 
dition. It is well known that children often show high temperature re¬ 
actions even in slight disorders; such as 104° F. in constipation. In some 
diseases there is a regular alternation between morning and evening tem¬ 
peratures (for instance, in hectic fever in tuberculosis); and a reliable opinion 
can be formed only if the pulse is taken into consideration simultaneously 
with the temperature. The pulse-rate usually bears a certain relation to 
the height of the fever. Thus a temperature of 100.4° F. with a pulse- 
rate of 120 a minute (the normal rate being about 72) must be considered 
much more serious than a temperature of 103° F. with the same or a smaller 
number of pulse-beats. Thus, it is not infrequently found that a serious 
attack of appendicitis is accompanied by only a moderate rise in tempera¬ 
ture (102 to 102.5 0 F.), but the pulse-beat is very rapid. This oifers more 
evidence of the seriousness of the affection than does the temperature. 
On the other hand, the reverse, situation may be encountered in other affec¬ 
tions, as, for instance, in meningitis. 




Fifth Nerve 
Filaria 


THE STANDARD FAMILY PHYSICIAN 


344 


Brief attacks of fever in strong persons often require very little treat¬ 
ment, provided that the body is not prevented from giving off the excessive 
and annoying heat by means of nonsensical piling on of bed-clothes, d o 
cause the disappearance of high temperatures for a few hours by medicines, 
is merely a kind of self-delusion which a layman should never attempt 
on his own responsibility. If sufficient relief is not obtained by ample venti¬ 
lation of the sick-room (without exposing the patient to a draft) and slight 
covering of the body, it is permissible to resort to cool ablutions, moist 
packs, and cool baths (77 0 to 83° F.) until the physician arrives. In order to 
determine whether fever is present, it is essential to measure the tempera¬ 
ture with a clinical thermometer, as it can not be done by merely feeling the 
forehead (see Observation of the Sick). Many patients may have high 
internal temperatures although their skin is cold. 

At the present time it is unscientific to speak of simple fever. Practi¬ 
cally every rise in temperature is due to a definite disturbance. The vast 
majority of these disturbances is due to infection from micro-organisms, or 
to their poisons. All patients with fever should be watched carefully until 
the cause is established. Children with sudden rises of temperature should 
be isolated at once if other children are in the family, for the fever may be 
the initial symptom of a contagious disease, such as measles, scarlet fever, 
whooping-cough, etc. On the other hand, it may be only a symptom of 
constipation, but parents can not be too careful in their attempts to avoid 
contagious diseases. The ounce of prevention is worth many tons of cure. 
Neglect often leaves hearts that sorrow for a lifetime. There is only one 
general rule that is safe in practically all cases. Isolate the patient, espe¬ 
cially if a child; give a cathartic, and let the family doctor decide as to the 
cause of the fever. He may not be able to tell at once, but in time the 
precise cause may be learned. 

FIFTH NERVE. — See The Nervous System, in Introductory 

Chapters (p. 67). 

FIG. —The partly dried fruit of a small shrub or tree, Ficus Carica , 
native to southwestern Asia, and extensively cultivated in tropical and semi- 
tropical lands. Figs contain from 50 to 60 per cent, of glucose, with gum, 
fats, salts, and a high percentage (15 per cent.) of cellular tissue. By rea¬ 
son of the large amount of sugar, figs are useful in overcoming chronic con¬ 
stipation, toward which end the indigestible cellulose and seeds contribute, 
if they do not play the major part. 

FILARIA. —The name of a widely distributed genus of small parasitic 
worms found extensively throughout the world, and often the cause of 
serious disease in man. The name is derived from the Latin filum (mean¬ 
ing “thread”) and refers to the thread-like shape of these worms. The 
most important of the different species of filaria are Filaria medinensis or 
the guinea-worm, Filaria loa . and Filaria Bancrojti , known also as Filaria 







U 5 


THE STANDARD FAMILY PHYSICIAN 


Fifth Nerve 
Filaria 


sanguinis hominis. A number of other species are known, but they are 
better discussed in works on worms. 

The guinea-worm is one of the best known of the various species, as it 
has been written about from the earliest times. It has been assumed that 
the fiery serpents that plagued the children of Israel were these worms, and 
the sacred and medical books of the East, as well as those of the middle 
ages, abound in references to this scourge. The length of this worm varies 
between 12 and 15 inches, and its breadth between and J of an inch, and 
it is more or less uniformly thread-like in general shape. Two sexes are known, 
male and female, and the female is often found as a parasite in the human 
skin. It is thought that the young worm is harbored in the bodies of cer¬ 
tain minute water crustaceans ( cyclops ), and that it is either taken in with 
the drinking-water or occasionally enters directly into the skin in those whose 
occupation requires them to stand for a considerable length of time in 
water which is liable to be contaminated. The worm is very frequently 
found in many of the lower animals, and it grows to its full size in cattle, 
horses, dogs, and wild cats. The affection which may be caused by the 
worm is in the nature of a boil or abscess. It is most frequently found in 
the lower extremities, especially in the feet and ankles, but it may also be 
found in different parts of the body. Until the worm appears at the sur¬ 
face, its presence is rarely detected; and very frequently a running sore may 
have at its base, half an inch or so below the surface, a collection of these 
worms. The native home of the Filaria medinensis is largely Africa, and 
it is interesting to note that in the early days of slavery this disease was com¬ 
paratively common among the negroes of the United States. However, 
it has not to any great extent found a home in the southern states, and 
original cases are extremely rare. 

The Filaria loa is not so well known. It is smaller, and comes from 
about the same region as the Filaria medinensis , namely the Gold Coast of 
Africa. Like the guinea-worm, it is in all probability first introduced into 
the lower forms of crustaceans, and thence into man through the drinking- 
water. As a rule it chooses the orbital region rather than any other part 
of the body, but it is known to occur also in other situations. Not infre¬ 
quently it has been known to enter the eyeball itself, and medical records 
enumerate thirty or forty cases in which the worm has been extracted from 
the eyeball. Most frequently, however, it is located in the region beneath 
the eyelid. 

The Filaria Bancrofti, known also as Filaria sanguinis hominis , is an 
extremely interesting parasite, as it is very frequently found in the human 
body. It is thought to be communicated to man largely through the in¬ 
fluence of mosquitoes, and it is not at all impossible that it is obtained through 
drinking-water, especially water in which mosquitoes aie apt to breed. The 
parasite usually develops in the lymphatic tissues of the body, and may also 





5 i%fi«^ ralysis THE STANDARD FAMILY PHYSICIAN 


346 


be found in the blood stream, but it is more likely to occlude the large lym¬ 
phatics and bring about their dilatation, thereby causing the characteristic 
picture of elephantiasis—enlarged veins and monstrous structures in dif¬ 
ferent parts of the body. It is a comparatively common parasite in the 
tropics of Asia. Africa, and Australia, and in some islands of the southern 
Pacific, particularly in Samoa, where it is stated that forty or fifty per cent, of 
the inhabitants are infected. Thus far it has not obtained a strong foot¬ 
hold in the United States, although it is not unlikely that it may spread. A 
large number of closely related Filarice are known, but they can not all be 
considered in this place. See also the article on Worms. 

FINGER PARALYSIS.— See Paralysis. 

FINGER SNAPPING.— Many persons are able to make a cracking noise 
by bending or stretching their fingers beyond a certain point. This is due 
to the fact that, owing to inequalities and to nodular thickenings in the 
tendon, a stronger pull is required to make the tendon pass through the 
narrow portions of its sheath. Therefore, as soon as the narrow point is 
passed, the tendon slides with a jerk into the desired position. It seems, 
however, that changes in the phalanges, uneven joint-surfaces, etc., may 
sometimes be factors in causing this phenomenon. It is a useless and harm¬ 
ful trick, which frequently injures the joints; if practised often it almost 
invariably leads to joint-deformities. 

FISH-SKIN DISEASE (ICHTHYOSIS). — A disease characterized by 
dryness of the skin of the entire body. The natural fat of the skin is absent; 
it is rough and lusterless, and appears as if covered with dust. The upper¬ 
most layer of the skin is variously fissured, especially on extensor surfaces, 
so that smaller or larger, round or polygonal, scale-like plates develop. 
The scales are either thin, white, and glistening, or thick and of a greenish- 
gray color. In the center they adhere to the base, whereas they are free at 
the edges, and they constantly drop from the skin. The armpit, elbow- 
joint, knee-joint, and the inguinal fold are exempt from the disease. Owing 
to the fissures of the upper layer of the skin, the malady is annoying and un¬ 
sightly, but it is never dangerous. The treatment consists of baths, soap 
ablutions, and embrocations of fat. Ichthyosis is probably a hereditary 
affection. 

FISTULA. —An abnormal, more or less narrow passage which either 
leads from a cavity of the body, or from the interior of an organ, to the sur¬ 
face of the body; or establishes a connection between two organs, as for 
instance, between the bladder and the vagina. Complete fistulas are to be 
distinguished from blind ones in that the latter have but one opening. 

Fistulas are mostly due to deep-seated, chronic, purulent inflammations, 
which finally discharge through the skin (bone and breast fistulas). They 
may result from injuries; for instance, from penetrating foreign bodies such 
as bullets or splinters which were not removed in time; or from the injury 







347 


THE STANDARD FAMILY PHYSICIAN Fiatuienc aralysis 

due to long-lasting pressure of the infant’s head in difficult deliveries. This 
last-named cause may give rise to a fistula between the bladder and the 
vagina. Disturbances of the development of the fetus in the womb fre¬ 
quently gi\e rise to fistulas by causing parts to remain open which should 
have been united (throat and navel fistulas). 

Fistulas are named according to their location, or according to the fluid 
discharged from them. Thus, in many old tuberculous bone-diseases, 
tuberculous fistulas develop. These lead down to dead and dying bone. 
Openings from the intestines result in fecal fistulas. With regard to rectal 
fistulas, which are very common, see Rectum, Diseases of. The treat¬ 
ment of the affection, which rarely heals spontaneously, often encounters 
great difficulties; surgical interference is normally required. 

FIT. —See Convulsions. 

FLATFOOT.— A deformity caused by the breaking down of the normal 
arch of the bones of the foot. It is characterized by the fact that the affected 
foot, in the standing position, touches the 
ground with all parts of the sole instead of 
with only the heel and the balls of the toes 
(see Figs. 38, 39). The condition of being 
flatfooted is associated with many annoy¬ 
ances. The patients tire readily, they are 
not able to stand for any length of time or 
to walk far, the feet are very liable to per¬ 
spire, and varicose veins arise upon the lower Fig l * 1 - Inso ^tUD 0 t he correction of 
leg and the foot. Persistent local pains, often 

treated for years as rheumatism of the feet, particularly by quacks, are almost 
invariably due to this condition. The affection develops principally in young 
persons who are obliged to stand constantly, or who perform hard work 
while standing. Any one, therefore, who has a tendency to this condition 
should not select a calling which imposes special strain on the feet; or 
should in time exchange it for another. Flatfoot sometimes occurs as a 
congenital defect; and it may be acquired also by injuries to the foot, for in¬ 
stance, after fracture of the heel-bone. The treatment consists in massage 
of the muscles of the lower leg and foot, together with the wearing of special 
insoles (see Fig. 141) and splints. Very severe cases must be cured by 
operation. Special shoes are advisable; but they should be ordered by a 
competent physician and not by a shoemaker. 

FLATULENCE. —A condition due to excessive fermentation or putre¬ 
faction of food in the intestinal canal, and characterized by the discharge 
of gases from the stomach or through the anus. The gastro-intestinal canal 
always contains a certain amount of gases, which in excessive quantities may 
produce a very tense condition of these organs. Ordinarily these gases are 
passed with the stools. If ejected at other times, they are very noticeable 










Flaxseed 

Foodstuffs 


THE STANDARD FAMILY PHYSICIAN 


348 


on account of their odor which resembles that of rotten eggs, and which is 
due principally to the contained hydrogen sulfid gas. Any considerable 
increase in the quantity of intestinal gas is usually due to increased decom¬ 
position of the food in the intestine. If foul-smelling, it may be due to the 
ingestion of a large quantity of proteid materials, such as meats, eggs, etc. 
Gases of an acid smell are usually due to fermenting carbohydiatcs, starches, 
sugars, etc. A profuse development of gas is not harmful, so long as the con¬ 
tractions of the intestinal musculature are sufficiently strong to expel it. But 
when the gas collects, it causes more or less distention of the various intesti¬ 
nal loops, as well as of the abdominal walls, from which much discomfort 
with colicky pains may result. 

The expulsion of gas is prevented in cases of paralysis of the intestinal 
muscles, such as may be seen in inflammations of the appendix or perito¬ 
neum; also in partial or complete occlusion of the lumen of the bowel, and 
in volvulus. In these conditions, inflation of the gut is one of the serious 
symptoms. In ordinary cases there is merely a feeling of fulness and dis¬ 
tention in the abdomen, sometimes colicky pains, but the discomfort soon 
passes away. But when the pain persists for a time, it should not be as¬ 
cribed to gas and subjected to various household remedies in the hope of 
improving it. Gas is not always the cause of such painful attacks, and 
much valuable time may be lost during which it would have been wiser to 
have called in a physician. Various remedies are employed in order to 
prevent to some extent the formation of excessive amounts of gas; but it 
is most important that the bowels be thoroughly emptied daily. Continued 
flatulence is an evidence of dietetic indiscretion, or of dyspeptic disorders. 

FLAXSEED (LINSEED). —The seed of the flax-plant or Linum usita- 
tissimum, a plant which is native to Europe and widely cultivated in dif¬ 
ferent parts of the world. The seeds, which contain mucilage, oil, and 
starch, are widely used as a poulticing material in the form of a paste. By 
reason of the large percentage of fat or oil that the seeds contain, the heat is 
retained for a long time. Flaxseed has no inherent healing properties of 
itself. In fact, it is a very unhygienic and insanitary form of dressing; and 
it has simply its convenience, cheapness, and adaptability to recommend 
it. A mixture of equal parts of linseed-oil and lime-water, called Carron 
oil, is one of the best local applications for burns. By virtue of the muci¬ 
lage which it contains, flaxseed-tea makes a very palatable demulcent, 
particularly in sore throats and in irritated conditions of the stomach and 
intestines. It is especially valuable following the administration of poisons. 

FLESH. — See Meat. 

FLUKES. —See Parasites. 

FCENICULUM (FENNEL). —The dried fruit of Fceniculum vulgare, a 
herb extensively grown in southern Europe. In the United States it has 
more or less escaped from cultivation, and become naturalized. It contains 







349 


THE STANDARD FAMILY PHYSICIAN 


Flaxseed 

Foodstuffs 


a high percentage of volatile oil, the most active constituents of which 
are camphors. Fennel is useful as a stimulant to the mucous membrane 
of the stomach, causing warmth, and increasing the intestinal movements; 
given together with cathartics it is capable of relieving cramped conditions. 
It is rarely used alone, one or two drops of the volatile oil being a sufficient 
dose. 

FOODSTUFFS. —From a broad point of view foodstuffs include all those 
substances which are necessary to build up the body. These may be de¬ 
rived from organic nature, or from the inorganic world. Thus the oxygen 
of the air is one of the most important of the foods of the human body. 
Water is absolutely essential to the maintenance of life, eighty per cent, of 
the human body being composed of this food material. 

In the usual acceptation of the word, however, foodstuffs include only 
those substances which are derived from the vegetable and animal king¬ 
doms, together with the nutrient salts from the mineral kingdom. With 
the limitation to this simplified view it must be emphasized, in the first place, 
that any one who eliminates one of these three groups from his food, or 
uses them in undue proportion, will sooner or later suffer for it in health 
or in functional capacity. The abuse of nutritive salts is less liable to cause 
injurious manifestations, since they are naturally present in vegetable and 
animal foods, and therefore less subject to arbitrary preferences. Those 
who drink very large quantities of water will suffer from such excess; no 
less than those who drink no water at all. The strict vegetarian—it might 
be interpolated that there are none—will suffer as well as he whose diet con¬ 
sists exclusively of meat. Faddism in eating is one of the silly excrescences 
of the half-informed mind. 

It is important to remember, however, that disturbances of health may 
be due to food. This refers not only to affections of the stomach and in¬ 
testine, but also to a large number of metabolic disorders, such as obesity, 
the formation of calculi, migraine, diabetes, and gout. The excessive use 
of meat is objectionable, and those who stuff themselves with this article 
of food to the point of gluttony will find no advocates; but the same may be 
said with regard to vegetarianism in so far as it exists, most people who call 
themselves vegetarians including in their bill of fare such important animal 
foods as cheese, milk, and eggs. The first man known to history was a 
hunter and a nomad. He lived on meat and roots, if he could find them. 
In a higher stage of culture he became an agriculturist, and raised his cattle 
and wheat. Bread and meat are therefore the foods of thousands of years 
of adaptation. 

Chemistry has demonstrated that all these foodstuffs (vegetable as well as 
animal) contain three primary types of substances which constitute the 
food required by man. These are proteids (containing nitrogen), carbohy¬ 
drates (non-nitrogenous), and jats. Proteids are found in largest proportions 





Foodstuffs 

Foreskin 


THE STANDARD FAMILY PHYSICIAN 


350 


in meat, fish, caviar, cheese, milk, and in oysters and other shell-fish. 
They make up a considerable proportion also of legumes and cereals, and 
practically no organic substance is without a small proportion. Carbohy¬ 
drates, or sugar-forming substances, are most abundant in plants, as leg¬ 
umes, cereals, fruits, and vegetables; they are present in small quantities 
also in most animal foods, as butter, lard, tallow, and oil. Hence all three 
types of nutrient materials are represented in all classes of foods. The 
exact figures for some foods are shown in Plate XIX., from which it will 
be seen that carbohydrates are derived principally from the vegetable king¬ 
dom; whereas proteids and fats may be obtained from either the animal 
or the vegetable group. 

, From a strictly chemical point of view, it makes little difference from 
which class of foods the different materials may be taken. They exist in 
varying proportions in all foods. A cow can grow fat on grass, but it usu¬ 
ally has to eat for eighteen hours a day to do so. Physiological chemists 
have determined the exact quanta necessary to keep a man alive under dif¬ 
ferent conditions (regarding work, etc.); and a dietary can be constructed 
to meet these demands. Comparative tables have been constructed to 
show the equivalents in food values, and a well-balanced dietary will in¬ 
clude sufficient nourishment at a reasonable figure. Cheese, for instance, 
is one of the most valuable of foods, in proportion to its price. Another 
very important point to be considered is the subject of digestibility. For 
instance, on the surface it might be considered, and is very frequently so 
taught, that mushrooms are as useful as meat because they contain an 
equally high percentage of proteids. It must be borne in mind, however, 
that the proteids of the mushrooms are not fully utilized by the digestive 
organs; hence the very highly prized chemical factor is a misleading 
one. In fact, the chemical food experts have constructed very useful 
tables; but they are all defective, and are merely suggestive, because the 
problems regarding digestion have not been taken into sufficient account. 
Personal idiosyncrasy of digestion is also a disturbing factor. Thus, enor¬ 
mous differences exist with reference to the ability of different individuals 
to utilize fats. For this reason the card philosophies of the “nut-food” faddists 
often come to grief because of the indigestible fats that many nuts contain. 

The general question of digestibility is one to which the layman is ac¬ 
customed to attribute a fixed, and therefore erroneous, meaning. For it 
may be said that there is scarcely a subject of the human economy which 
is exposed to greater variations; and in no other respect does personal pre¬ 
disposition play a greater part than in that of the digestibility of food. A 
dish which may be readily digestible to one person, may be very troublesome 
to the digestive organs of another. The digestibility of a foodstuff depends 
not only upon its natural qualities, but also upon numerous other factors, 
such as appetite, palatability, and proper mastication. 







351 


THE STANDARD FAMILY PHYSICIAN 


Foodstuffs 

Foreskin 


Numerous tables have been constructed purporting to show the com¬ 
parative digestibility of various foodstuffs. These, however, should be in¬ 
terpreted only in the most general way. In view of the many factors which, 
as has. already been pointed out, enter into the question, one might almost 
say that they are worthless. Many of the individual idiosyncrasies are 
due to chemical reasons; others to mental reasons. There is very little 
use arguing with the man who says that milk disagrees with him. It is 
bound to do so as long as he thinks it will; for there is no part of the human 
body which is more profoundly subject to the impressions of the mind than 
the stomach. To reinforce the truth of this assertion, it is only necessary to 
refer to the relationship which the emotions bear to the appetite. An indi¬ 
vidual can make himself, as well as others, very miserable by constantly 
wondering whether or not a certain kind of food will agree with him. 

There are still other factors that determine the digestibility of the va¬ 
rious foods. Whether a greater or less amount of bile is present, is of im¬ 
portance with regard to fatty emulsification; variations in the pancreatic 
secretion affect all three types of food-principles, the fats particularly; and 
variation in the strength of the muscular coats of the intestines is also a de¬ 
termining factor in the question of digestibility. Then again, all foodstuffs 
are composites. Their contained sugars may diffuse rapidly; their pro- 
teids may soon be digested; and their fats last. Hence, any table pre¬ 
tending to tell when a substance is fully digested, is a delusion and a snare; 
it may be helpful in a most general way, but it should not be interpreted too 
literally. The following table is one widely quoted, but it shares the de¬ 
fects of all the others in that it contains too many general statements. Thus, 
to illustrate, it states that celery is digested in ij hours, when, as a matter 
of fact, certain parts of the celery are never digested but thrown out in the 
feces. It is inserted here as an instance of one man’s guess about the di¬ 
gestibility of certain foods. It might be surmised that it represents his 
personal experiences. They are worth so much and little more. 

One hour: Boiled rice. One and one-hal) hours: Beaten eggs; barley 
soup; roast venison; stewed fruits; boiled trout; spinach; asparagus; 
celery; brains. Two hours: Boiled milk; turkey; boiled, pickled pork; 
baked potatoes; peas; beans; roast tenderloin. Three hours: Smoked 
ham; stewed mutton; boiled carrots; cabbage. Three and one-half hours: 
Boiled beef; roast pork; corned beef; boiled potatoes; fresh wheat-bread. 
Four hours: Boiled and broiled poultry; roast veal; dry bread. Four and 
one hal) hours: Boiled, fresh pork; boiled mutton. Five hours: Mush¬ 
rooms; nuts. Six hours: Fried eels; stale corned beef. Fluids are absorbed 
comparatively quickly by the body. See also the articles on Bread; Fri its, 
Meat; Vegetables; etc. 

FORESKIN, DISEASES OF. —Diseases of the foreskin are generally 
accompanying symptoms of other diseases, especially of inflammatory 




Formaldehyde 

Fruits 


THE STANDARD FAMILY PHYSICIAN 


352 


affections of the male organ. A congenital deformity of frequent occurrence 
is phimosis. This condition consists in an abnormal constriction of the 
prepuce, which makes it exceedingly difficult, if not altogether impossible, 
to uncover the glans penis. If the foreskin is forced back behind the glans, 
it frequently happens that it becomes impossible to again push it forward, 
in which case the constriction of the glans may give rise to edema. If the 
constriction and consequent swelling of the glans is allowed to remain for 
a prolonged period, gangrene may result. The same unpleasant conditions 
arise if the phimosis is the result of an inflammatory process. In congeni¬ 
tal phimosis it is always advisable to resort to an operation (Circumcision). 
This should be done in early childhood, when the small size of the parts 
and the absence of sexual excitement give promise of a speedier healing. 
This operation will avert simply and permanently a deformity which under 
all conditions would promote the occurrence of inflammations and of sexuai 
diseases. If the operative treatment has been neglected in youth, it must 
be undertaken later on. 

If congenital constriction has already caused inflammation, an opera¬ 
tion is generally the most advisable measure. The same treatment is in¬ 
dicated when the phimosis is due to inflammatory processes which fail to 
yield to the proper remedies. In such cases a forcible attempt to lay bare 
the glans may give rise to constriction and all its consequences; it is best, 
therefore, to expose the source of the inflammation in order to establish an 
exact knowledge of the disease, or to arrive at a more successful treatment. 
In all cases of inflammatory phimosis the treatment should be left to the de¬ 
cision of a physician. The fact should be emphasized, that the operation 
is always without danger, and the result favorable. 

In the treatment of simple inflammation of the foreskin (a frequent result 
of gonorrhea), it is generally sufficient to observe quiet, to keep the member 
in an elevated position, to apply cool compresses to the sac, and to irrigate 
it with weak, non-irritating disinfectants. For the relief of constriction 
of the glans, medical aid should always be sought. When the condition is 
of recent occurrence, a return of the foreskin to its normal place is gener¬ 
ally effective; in other cases operative interference is necessary. In all dis¬ 
eases of the foreskin it is essential to consult a physician as soon as possible, 
in order that the normal function of the male organ may be preserved. It 
is not advisable for the patient to attempt self-treatment. 

FORMALDEHYDE. A gas obtained by the incomplete burning of 
methyl alcohol or wood-alcohol. It is a very irritating and destructive gas, 
which is used in a solution of 40 parts to 100 of water. In the gaseous form 
it is widely used as a disinfectant; and in a weak solution of one-half to one 
per cent, it is used as an antiseptic wash; but by reason of its irritating 
qualities it is not adapted to surgical antisepsis. See Antiseptics. 
FRACTURES. —See Bone, Fractures of. 




353 


THE STANDARD FAMILY PHYSICIAN 


F ormaldehy de 
Fruits 


FRANGULA.—The dried bark of the alder-buckthorn (Rhamnus jran- 
gula ), a slender shrub indigenous to Europe and parts of Asia. Its active con¬ 
stituents resemble those of Cascara (which see), and it is widely employed 
as a laxative and cathartic. 

FRECKLES. —See Skin, Care of. 

FREEZING.—Distinction is made between three grades of freezing. 
The first grade is characterized by bluish-red discoloration of the skin, ac¬ 
companied by considerable itching and painfulness; the second grade, by 
the formation of blisters which are usually filled with a blood-colored fluid; 
and the third grade, by gangrene of the frozen parts. The body of a frozen 
person is icy cold to the touch, the skin is pale, and the limbs are stiff. The 
respiration, if present at all, is scarcely noticeable; and the pulse can be 
felt only with difficulty. This condition may gradually pass over into 
death, as is not infrequently observed in persons who, worn out by a long 
walk or by the abuse of alcohol, lie down in the open air despite the cold, 
and fall asleep never to wake again. 

The leading principle in the resuscitation of persons who are frozen 
should be gradual warming. The following method is an appropriate one: 
Remove the frozen individual into an unheated room; disrobe him care¬ 
fully; rub the body with cold, wet towels, or with snow; or place him in a 
full bath of cold water (6i° to 64° F.). Continue rubbing the body, slowly 
and gradually raising the temperature of the bath to 86° F. in the course of 
two to three hours. After the limbs have become a little more movable, 
resort to artificial respiration if necessary. When the patient begins to 
breathe spontaneously he should be placed in an unheated bed, and covered 
with blankets. The room should then be gradually heated to a moderate 
temperature; and later the patient may be rubbed with towels gradually 
made warmer and warmer. As soon as the patient is able to swallow, he 
may be given wine or other alcoholic beverages, as well as tea or coffee in 
large quantities. Consciousness is not fully restored until several hours have 
passed; sometimes only after days. 

FROG-TONGUE.— See Ranula. 

FRUITS.—The most important edible fruits are: the apple, pear, orange, 
lemon, banana, grape, peach, cherry, raspberry, strawberry, blackberry, 
huckleberry, pineapple, and fig. They all contain a large percentage of 
water, a moderate amount of carbohydrates, and small quantities of pro¬ 
tein and fat. The table on page 354 shows the composition of the fruits 

enumerated above. 

The process of drying lowers the percentage of water to about 20, and 

increases that of carbohydrates to about 70. 

The nutritive value of fruits is comparatively small, depending chiefly 
on the percentage of carbohydrates which they contain. They influence the 
system beneficially, however, on account of their salts and acids, for which 




Fruit-Wines 
Gall-Stones 


THE STANDARD FAMILY PHYSICIAN 


354 


reason they are to be especially recommended to persons suffering from 
habitual constipation. Fruits also tend to stimulate the appetite, a virtue 
which gives them a value far superior to that of their actual nutrient 
qualities. 

The composition of nuts differs widely from that of the fruits considered 
in the foregoing. With few exceptions, they contain very little water (4 to 10 
per cent.), while their percentages of carbohydrates, protein, and fat are 
high. The almond, for instance, contains more than 20 per cent, of pro¬ 


Fruit 

Water 
per cent. 

Fat 

per cent. 

Protein 
per cent. 

Carbohydrates 
per cent. 

Salts 
per cent. 

Apple. 

84.7 

o -5 

o -5 

x 3 • 9 

0.4 

Pear. 

84-5 

0-5 

0.7 

13.8 

o -5 

Orange. 

87.0 

o -3 

1.0 

11.1 

0.6 

Lemon. 

88.9 

0.8 

1.0 

8.9 

0.4 

Banana. 

75-7 

0.7 

1 .5 

21. 1 

1.0 

Grape. 

78.0 

1 • 7 

1.4 

18.2 

0.7 

Peach. 

79.2 

o -3 

1.2 

18.7 

0.6 

Cherry. 

81.2 

0.9 

1.1 

16.2 

0.6 

Raspberry. 

86.0 

o -3 

1.2 

11.8 

0 • 7 

Strawberry. 

91.0 

0.8 

1.2 

6.3 

0 • 7 

Blackberry. ? . 

87.1 

0.9 

1 • 5 

9 • 9 

0.6 

Huckleberry. 

82.1 

0.7 

0.8 

16.0 

0.4 

Pineapple. 

90.0 

0.4 

o -5 

8.6 

0.5 

Fig. 

78.6 

0 • 3 

i -7 

18.7 

0.7 


tein, more than 50 per cent, of fat, and nearly 20 per cent, of carbohydrates. 
Nuts, therefore, contain nutritive substances in abundance; but they are 
not readily digested. They are largely used in the manufacture of candies 
and cakes; while some nuts yield valuable salad-oils. For such fruits as 
the tomato, melon, cucumber, etc., see Vegetables. 

FRUIT-WINES.—Several varieties of fruits and berries are used for 
the manufacture of wines. Among these are huckleberries, currants, goose¬ 
berries, pears, and apples. The mode of preparation is much the same as 
that of grape-wine. The fruits are pressed and the juice left to natural 
fermentation until it is ripe for bottling. To currant and huckleberry wines 
a large quantity of sugar is usually added at the beginning of fermentation, 
thus increasing their contents of alcohol to as much as 16 per cent., and 
causing them to resemble southern wines. Cider is generally prepared 
from apple-juice, and usually contains about 5 per cent, of alcohol, or the 
same amount as strong beer. 

FURUNCLES.—Affections originating in a hair-follicle or in a gland of 
the skin, and generally due to uncleanliness. They are located especially on 
those parts of the skin which are subject to pressure or friction; for instance, 
on the neck (resulting from narrow and stiff collars), on the shoulder (due 
to pressure of the suspenders), and on the loins and hips (as a consequence 
of tight waist-bands). Furuncles are often caused also by improper water- 

































355 


THE STANDARD FAMILY PHYSICIAN 


Fruit-Wines 

Gall-Stones 


cures; and sometimes they arise in connection with general affections, such 
as tuberculosis, or diabetes mellitus. 

Furuncles have nothing to do with impurity of the blood; they are local 
inflammations only. As a rule several furuncles arise at the same time. 
The affected parts of the skin are red, inflamed, smooth, glistening, and 
painful. After a few days a point of pus develops in the center of the in¬ 
flamed part. This pus may be pressed out with clean hands, or the furuncle 
may be opened with a needle which has been previously heated over an 
alcohol flame. It is best to consult a physician as early as possible; and 
such consultation is absolutely necessary if the furuncles are very large. 
This will best prevent serious consequences, such as supervention of ery¬ 
sipelas, etc. As a result of an infection with the pus of an existing boil, 
new furuncles may develop upon adjacent portions of the skin. For this 
reason it is popularly and correctly maintained that “the occurrence of one 
boil is followed by seven others.” In order to prevent further infections, 
it is therefore advisable to lead a temperate life and to attend carefully to 
the cleanliness of the skin. 

Extremely numerous furuncles are often observed in small children, 
especially in such as are scrofulous, or debilitated by other diseases. These 
boils should be opened as early as possible by a physician, as neglect of the 
condition is very apt to result in extensive inflammations. Baths with 
disinfectants added to the water are also beneficial. 


G 

GALLA (NUTGALLS). —These are excrescences on various species of 
oaks, produced by puncture and the depositing of ova by certain insects 
(Cynips). The galls contain a high percentage of tannic acid, and are 
used in medicine for much the same purposes as the latter; namely, for 
astringent mouth-washes and douches, and occasionally in the tieatment of 
subacute and mild diarrheas. 

GALL-STONES.— Stones which develop in the gall-bladder or (occasion¬ 
ally) in the liver. Ancient physicians regarded them as due to simple 
inspissation or drying up of the bile; but at present the real cause is con¬ 
sidered to be due to chemical changes in the bile, which in turn probably 
result from an inflammation of the mucous membrane of the gall-bladder. 
Three-fourths of all cases of gall-stones occur in women, generally after 
the fortieth year of age. This extreme frequency is undoubtedly related 
to the habit of wearing tight corsets which may obstruct the flow of the 
bile. Many physicians assume also that there exists a certain connection 
between pregnancy and the formation of gall-stones. People of sedentary 
habits often suffer from this complaint; and it is ascribed also to overeating 





Gall-Stones 

Gang-lion 


356 


THE STANDARD FAMILY PHYSICIAN 


(especially of meat) and to excessive use of alcoholic beverages. In cer¬ 
tain districts the occurrence of gall-stones is very frequent, and has been 
ascribed to an abundance of lime in the drinking-water. Bacterial infec¬ 
tion, especially typhoid, is an important causative factor; and in certain 
families it seems that heredity also plays a part. 

The size of gall-stones varies from that of a grain of sand to that of an 
egg. Sometimes only a single stone is found, but usually ten to fifteen 
small ones accumulate, and cases are on record in which as many as one 
thousand, and more, have been found in one gall-bladder. The stones 
are generally round, or sharp-cornered (see Plate XIII., 2), although at 
times they are pear-shaped like the gall-bladder. Their surface may be 
either uneven or smooth, and their colors vary between all shades of green, 
brown, yellow and black. When fresh, they can be crushed between the 
fingers. Gall-stones are usually composed of the same materials which form 
the constituents of the bile: cholesterin, lime-salts, etc. 

In some cases it happens that persons affected with gall-stones remain 
unaware of this fact, the stones being accidentally discovered at an autopsy. 
In other cases the patients suffer but slightly, and the stones are found in the 
excrements by mere accident; this is especially often the case in the aged. 
The presence of gall-stones is generally recognized by attacks of so-called gall¬ 
stone colic. This colic is brought about when the stones, on leaving the 
gall-bladder, become engaged or stuck in their passage through the bile- 
ducts. Such an attack may take place but once, or it may recur at vary¬ 
ing intervals of months or years. Many persons become subject to such 
attacks after riding or dancing, or after vexation, but especially after eating 
too much. During the attack the patient is affected by a boring, burning, 
piercing, or crushing pain in the pit of the stomach or in the right side 
of the abdomen; this pain may radiate into the right thigh and testicle, into 
the back, and into the right (rarely into the left) shoulder and upper arm. 
The pain, which is often all but unbearable, causes the face to become 
distorted with a look of fright, and the forehead to be covered with cold 
sweat. The patient presses his fist into the region of the liver, and leans 
forward with his knees bent; often he writhes on the floor in his agony. 
The abdomen in the region of the liver is extremely sensitive to pressure; 
and when the region of the gall-bladder is touched, the patient may scream 
with pain. Violent chills and fever, vomiting, hiccup, etc., are frequent 
manifestations of the affection. The stools are generally retarded, and 
the quantity of urine is scant. Unconsciousness is not an infrequent accom¬ 
paniment of an attack. An attack generally lasts from three to five hours, 
and although it usually terminates favorably it is often followed by jaundice. 
Some patients have frequent attacks of gall-stone colic which may not 
be recognized as such; and they are not infrequently treated for other 
affections. 





357 


THE STANDARD FAMILY PHYSICIAN 


Gall-Stones 

Ganglion 


In order to prevent the disease it is advisable to regulate the diet care¬ 
fully, and to eat only simple food in moderate quantities. Excesses in 
eating or drinking, as well as strong spices, should be avoided. Bodily 
exercise is very beneficial for those who follow sedentary callings. A cer¬ 
tain amount of caution should, however, be observed as to the form of 
exercise selected. Curative gymnastics are useful, and attention to regu¬ 
lar movements of the bowels imperative. Women should lay especial 
stress upon a rational mode of dressing, and should avoid the wearing of 
tight corsets. 

It needs hardly be mentioned that it is necessary to secure the advice 
of a physician, especially in an attack of colic. Until the physician arrives, 
attempts may be made to alleviate the pain by applying hot compresses to 
the painful parts of the abdomen, by drinking hot water, milk, or tea, and 
by administering a hot bath (104° F., or over). In many cases, however, 
cold applications are borne better than warm; and under such circumstances 
an ice-bag may be applied to the region of the liver. 

A course of treatment at some medicinal spa is often beneficial for the 
prevention of recurrences. Among European resorts may be mentioned 
Carlsbad, Neuenahr, and Vichy; among American , Virginia Hot Springs, 
Alma Springs, Mt. Clemens, etc. Those whose means do not permit 
them to visit any of these resorts, may take a “Carlsbad Cure” at home. 
Internal medication rarely relieves severe cases of gall-stones. Surgical 
aid must be sought, and it is a fact that hundreds of patients have been 
saved by operative measures. But a successful issue may not be expected 
if the surgical treatment has been too long delayed. 

GAMBOGE (CAMBOGIA).—A gum resin obtained by incision into the 
trunk or larger branches of the Garcinia Hanburii, a Siamese tree. It oc¬ 
curs in the market in cylindrical rolls, from one to three inches in diameter, 
bright yellow to orange red in color, without any smell, but with a very acrid 
taste. It is readily diffusible in water, forming a yellow emulsion. Gam¬ 
boge is a powerful cathartic, producing a large watery stool. The dose for 
this purpose is from two to five grains, given either in pill or emulsion. It 
causes much griping, and also nausea and vomiting, and is therefore rarely 
given alone. Overdoses may cause death. The drug is employed also 
for the expulsion of tapeworms, in doses of ten grains or more. Gam¬ 
boge is not a safe remedy, and should never be taken unless prescribed by 

a physician. 

GANGLION.—A hard tumor proceeding from the sheath of a tendon 
or from the capsule of a joint. Sinews and joints are suiiounded by a 
firm tissue, called respectively tendon-sheath and joint-capsule, which 
secretes a mucous fluid. This latter lubricates the sinews and joint sui 
faces, and keeps them smooth. After continued severe exeition, an increased 
quantity of this fluid is secreted, and is collected in blind pouches (or diver- 





Gangrene 

Gelsemium 


358 


THE STANDARD FAMILY PHYSICIAN 



ticula) developed from the tendon-sheaths and joint-capsules. The con¬ 
nection between this pouch and the joint-capsule or tendon-sheath (as the 
case may be) is sometimes entirely lost, and the sac becomes closed on 
every side. These diverticula are called ganglia, and distinction is made 
between those derived from tendon-sheaths and those that develop from 
joint-capsules. Ganglia occur principally over the wrist and over the 
extensor tendons of the arm (for instance, in piano-players). They are 
painful, and create a sensation of tension. It is sometimes possible to 
crush them by firm pressure, but they generally reappear; besides, this 
method of treatment, in which the family Bible or dictionary is used, is 
highly dangerous. Massage and great care of the hands are advisable. 
Stubborn ganglia which cause considerable annoyance may be perma¬ 
nently removed by operative interference, with¬ 
out incurring any functional disturbances of 
hands or fingers. 

GANGRENE. —Term applied to the death of 
parts of the body, due to impairment of their 
blood-supply. Fingers and toes, being furthest 


Fig. 142. Moist gangrene. Fig. 143. Dry gangrene. 

removed from the heart, are usually the first to suffer. Gangrene may 
be recognized by the black color which the limb assumes, and by the wrin¬ 
kled condition of the skin. It may be either humid or dry, depending 
upon whether the affected parts contain fluids which cause decomposition, 
or whether the dead part simply becomes dry and shrivelled (see Figs. 
142 and 143). 

Gangrene is observed in old people, in certain nervous diseases, in 
diabetes, with obstruction of a blood-vessel, from the effects of extreme 
heat or cold, from cauterization by corrosive acids, from the ingestion of 
large amounts of certain medicinal substances, and, finally, as the result of 
severe inflammations. The gangrenous parts may become gradually 
separated from the body in consequence of inflammatory processes. Treat- 









359 


THE STANDARD FAMILY PHYSICIAN 


Gangrene 

Gelsemium 


ment must be primarily directed to the cause of the trouble, and on account 
of the dangerous character of the latter it must be carried out with extreme 
care. Hospital gangrene is a particular variety which usually affects fresh 
wounds and is very contagious. It produces crater-like ulcerations, and 
is followed by extensive sloughing of the tissues. Thanks to the modern 
methods of wound treatment it has now practically disappeared. 

GAS-POISONING. —See Asphyxia; Poisoning. 

GASTRIC FEVER. —Term used to designate the comparatively rare 
cases of catarrh of the stomach which are accompanied with a marked 
degree of fever and with severe general symptoms, such as headache, dizzi¬ 
ness, or delirium. The disease may also be called febrile catarrh of the 
stomach. Formerly the designation “gastric fever” was often used for 
many diseases which are now recognized as mild forms of other affections, 
such as typhoid fever, influenza, etc. The treatment includes cold com¬ 
presses to the head, cold packs, etc., together with measures directed to 
the removal of the digestive disturbances. See Catarrh of the Stomach , s. v. 
Stomach, Diseases of. 

GASTRITIS (INFLAMMATION OF THE STOMACH).— See Stomach, 
Diseases of. 

GAULTHERIA (WINTERGREEN). —The dried leaves of Gaultheria 
procumbens , a very widely distributed herb growing in most parts of North 
America. Its active principle is a volatile oil containing a high percentage 
of methyl salicylate. Like the salicylates, the oil of wintergreen is used in 
the treatment of acute articular rheumatism, and may also be used exter¬ 
nally for the relief of neuralgia and local pains. 

GELATINUM (GELATIN). —The dried product obtained from the skin, 
ligaments, and bones of animals after treatment by boiling and removal of 
water. Gelatin is insoluble in cold water, but swells on immersion, and 
absorbs a quantity of water equal to ten per cent, of its weight. It is sol¬ 
uble in boiling water; and a solution of one part gelatin to 50 parts of water 
solidifies upon cooling, and is widely employed in the household as an 
important constituent of soups and of various jelly-like dishes. In phar¬ 
macy gelatin is used very widely as a coating material. In medicine it has 
no particular value, but it has been employed in surgery for certain techni¬ 
cal purposes. Gelatin is not utilized to any great extent by the body, its sole 
value as a food substance being that of sparing other constituents, notably 
proteids. Thus, while it may be said that gelatin has no direct food value, 
it may be seen to serve indirectly a useful purpose. 

GELSEMIUM. —The dried roots of Gelsemium sempervirens , or yellow 
jasmine, a woody twiner, climbing over moist woodlands in the southern 
United States, and extending also into Central America. It contains an 
amorphous alkaloid, gelsemiu, and an acid, gelsemic acid. This latier is 
thought to be identical with the substance found in the root of scopola. 





General Paresis 
Glanders 


THE STANDARD FAMILY PHYSICIAN 


360 


Gelsemium acts upon the motor end-organs in the muscles, depressing 
their activity; in large doses it may cause paralysis of the muscles, notably 
of the eyelids and extremities. It also affects the sensory end-organs, thus 
diminishing the sensation of pain, and it has been used to some extent in 
the treatment of neuralgia. It is a dangerous drug, and can be used only 
with considerable caution. 

GENERAL PARESIS. —See Brain, Softening of; Insanity. 

GENTIAN. —The dried root of Gentiana lutea , or yellow gentian, a plant 
growing widely in the mountainous districts of southern and central Europe. 
It contains a number of fatty and resinous principles, and several bitters 
which are probably glycosids, such as gentiopicrin to which the taste and 
action of the drug is due. Gentian is used in medicine as a bitter, increas¬ 
ing the appetite and promoting the flow of saliva and of the gastric juice; 
it is thus efficacious in various types of dyspepsia and constipation which 
are often due to digestive disturbances. It is frequently used in the form 
of a compound tincture in doses of from 15 drops to one-half teaspoonful. 

GERANIUM (SPOTTED CRANESBILL).— The dried rhizome of Gera¬ 
nium maculatum , a perennial herb very widely distributed, and growing 
abundantly in the eastern and central parts of North America. It contains 
tannic acid, sugars, and gums, and is useful as an astringent. At one time 
it was very extensively employed in the treatment of various types of diar¬ 
rhea, particularly in children, in which class of patients it is well borne 
because of its agreeable taste and non-irritating qualities. 

GERMAN MEASLES (RUBELLA). —For some time it was an open 
question whether rubella was an independent disease or merely a variety of 
measles or scarlatina. Only within the last fifty years has the opinion 
become prevalent to look upon rubella as an independent infectious disease. 
If it were merely a milder form of measles or scarlatina, recovery from either 
of these diseases would protect against an infection by rubella. Such, 
however, is not the case. 

Rubella most frequently affects children, and recovery from an attack 
usually renders the patient immune to the disease. The time elapsing 
between infection and the appearance of the eruption fluctuates between 
two and three weeks. Premonitory symptoms are generally absent. If 
present, they are similar to those of measles, varying in severity and in dura¬ 
tion. They consist of slight cold in the head, cough, and of moderate 
sensitiveness of the eyes to light. In a number of cases these symptoms 
are not observed until after the appearance of the eruption. 

The eruption, which resembles measles, appears first on the face, and 
spreads rapidly over the entire body. In some cases it is visible for only a 
few hours; in others, for several days. The spots are separate, round, 
pale-red in color, about the size of a pea, and slightly raised above the 
skin. Scaling is either very slight (dust-like), or altogether absent. The 




CI5300 JAMI32 OHA HIA5d8 —.XI 3TAJ8 

( wsiv sbi2 ) 




btoo Isniqa aril \o jsiuQ 
bioo bsniqS 
nundaiaO 


.S 

d 


(nifi-td ad) lo anfiidmam) latem biuG .1 

mindaieO .£ 
muIIadaiaO .8 


PLATE IX. —BRAIN AND SPINAL CORD 

( Side view ) 

1. Dura mater (membrane of the brain) 4. Dura of the spinal cord 

2. Cerebrum 5. Spinal cord 

3. Cerebellum 6 Cerebrum 


Plate IX 




































.. 


























> 




































































361 


THE STANDARD FAMILY PHYSICIAN GiTnders Paresis 

mild catanhal symptoms which, accompany the affection disappear rapidly. 
Fever may be absent during the entire course of the disease. The disturb¬ 
ance of the general health amounts to little or nothing, so that it is difficult 
to make the sick children stay in bed. Incidents of any importance are 
usually absent, and the course of the affection is always favorable. 

Rubella is most apt to be confused with a mild case of measles, and it 
requires a practised physician to distinguish one disease from the other. 
Since it is often difficult, even for the physician, to recognize the disease, it 
is obvious that a layman is absolutely unable to do so. It is desirable to 
isolate the patient from the rest of the family, as it is unnecessary to have 
even so mild an affection as German measles. If stricter precautions were 
taken with the milder affections people would learn the value of rational 
hygiene, and the severe infectious diseases could be more readily controlled. 
It is a sign of a defective understanding of the importance of hygiene to 
believe that “children must have certain diseases.” It is not necessary. 
Sickness is really due to ignorance in its truest sense. 

GINGER (ZINGIBER). —The scalded and dried rhizome of the ginger- 
plant, Zingiber ofjicinale, a perennial or biennial creeper indigenous to India 
and Jamaica. The rootlets are from one to four inches long, light ashen- 
gray externally, yellowish-white and fleshy internally, yielding a yellowish- 
brown powder. The Jamaica variety is called “white ginger,” because the 
rootlets, being deprived of covering, are white or pale yellow on the outside. 
The powder also is lighter than that of the Indian variety. Ginger has an 
agreeable aromatic odor, and a spicy, pungent, and burning taste. The 
peculiar flavor is dependent upon the presence of a volatile oil, which may 
be extracted by alcohol or water. 

Ginger is used as a stimulant in weakened conditions of the alimentary 
canal, such as dyspepsia, flatulence, etc. It is also frequently used as a 
vehicle for disagreeable drugs. When the root is chewed it irritates the 
mucous membrane of the mouth, and increases the flow of saliva. Applied 
externally to the skin, it acts as a blistering agent, causing redness. The 
dose of powdered ginger is from ten to thirty grains; of the infusion (made 
by adding one ounce of powdered ginger to a quart of boiling water), one 
or two ounces. The tincture of ginger is given in teaspoonful doses. 

GLANDERS. —A highly infectious bacterial disease occurring princi¬ 
pally in horses, donkeys, and mules; rarely in sheep, goats, and cats. The 
disease is occasionally transmitted from these animals to man. The entrance 
of the bacillus of glanders into the human body usually takes place through 
the mucous membranes of the respiratory passages, but may be transmitted 
also through the healthy skin. It occurs most frequently in soldiers (espe¬ 
cially cavalrymen), hostlers, drivers, farmers, etc. In cases where infection 
has taken place through the skin, the disease begins with pain, redness, 
and swelling of the infected part and of the neighboring lymph-channels, 




Glass Eye 
Glycerin 


THE STANDARD FAMILY PHYSICIAN 


362 


and with the formation of crusts, the decay of which causes extensive ulcer¬ 
ation. If the infection has been transmitted through the nose, the latter 
swells, becomes red, and secretes a thin, purulent or bloody, often fetid 
fluid. The progress of the disease leads to ulcers in the mouth, pharynx, 
larynx, bronchi, and lungs; and a general infection of the body may take 
place. 

The symptoms of a general infection consist in gradually increasing 
high fever with violent chills, hoarseness, cough with mucopurulent (often 
bloody) discharge, swellings of the joints, numerous ulcers of the skin, 
headache, delirium, and stupor. In acute cases the duration of this ex¬ 
tremely dangerous malady is a few weeks, but it may extend over months 
and years. If proper treatment is not begun at the very onset of the dis¬ 
ease, death usually terminates the sufferings of the patient. The necessity 
for all persons who come in contact with sick horses to exercise extreme 
caution is thus illustrated. 

GLASS EYE. —An artificial eye which serves to take the place of an eye 
that has been lost. It is shaped like a little bowl, and is curved to fit over 
the rounded remains of the eye, and colored to imitate the natural organ 
as closely as possible. The materials employed are glass, enamel, or porce¬ 
lain. An artificial eye is useful from the cosmetic as well as from the 
hygienic point of view. It supports the eyelids and prevents their becom¬ 
ing inverted, thus avoiding inflammations in consequence of friction of the 
eyelashes. The first artificial eyes were made by a Frenchman, Poisson- 
ceau, who in 1850 was followed by one Muller in Lauscha, Germany. 
Artificial eyes can now be obtained almost everywhere. 

GLAUCOMA. —An internal disease of the eye, which is characterized by 
an increasing sensation of pressure in the organ, and by the appearance 
of a peculiar change in the eye-ground, which, however, can be seen only 
with the aid of the ophthalmoscope. Severe pain is present, combined with 
the illusion of haze and of rainbow colors. Owing to internal changes the 
eye becomes useless unless an operation, which consists in the removal of a 
portion of the iris, is resorted to in time. Drops of atropin should never 
be used in this condition. The sight has often been irreparably damaged 
through neglect of this precaution. 

GLEET. — See Gonorrhea. 

GLOTTIS, SPASM OF. —A spasmodic condition of the diaphragm and 
of those muscles which move the vocal cords. It occurs chiefly in patients 
suffering from a pronounced or hidden attack of rickets, and principally 
during the months of January, February, and March. It is a very danger¬ 
ous disease, as it attacks young children of three months to two years of age, 
sometimes affecting all the children of a family. The attack comes on 
without warning, and is usually caused by sudden excitement or great 
fright. The child at first makes eager attempts to breathe, then stops 






363 


TIIE STANDARD FAMILY PHYSICIAN 


Glass Eye 
Glycerin 


breathing altogether, and stands with the mouth wide open and with the 
head thrown backward. The face turns purple, the veins of the head swell 
and protrude, and the eyes stare vacantly into space or roll heavily from 
side to side. In some cases there are spasmodic movements of the arms 
and legs, clenching of the hands, and distortion of the face, followed at 
times by involuntary passing of urine and feces. After being breathless for 
about half a minute the child makes several whistling inhalations, where¬ 
upon it revives unless another seizure sets in. If the spasm ceases, the child 
recovers quickly, is able to breathe as before, and the color of the skin 
becomes normal. Some children are cross and sleepy after an attack, 
others are as cheerful as usual. At times the tongue rolls back during an 
attack, closes up the passage of the glottis, and causes death by suffocation. 

If some children of a family have had these attacks, it is wise to try and 
ward them off in the younger children by letting them have plenty of pure 
air to breathe, and the food best suited to their ages; mother’s milk is 
preferable. Every disturbance of digestion is to be carefully warded off 
or controlled. During an attack, the child’s clothing should be loosened, 
a hot sponge applied to the larynx, and cold water sprinkled over its face. 
Pressure of the finger on the roof of the tongue or on the epiglottis will often 
stimulate the breathing. A child who has a spasm of the vocal cords must 
be treated by a physician, and needs the greatest care and attention. One 
of the most useful modes of treatment calculated to increase the resistance 
of these children is the daily sponge bath. In the severe cases the patients 
should be given a warm bath two or three times a day; and at the close of 
the bath the chest, neck, head, and spine should be sponged off with cold 
water. Cod-liver oil is useful in these cases. Particular care must be 
taken by the mother that the dangerous true croup, or laryngeal diphtheria, 
is not confused with this comparatively mild affection. 

GLUCOSE. —A mixture of several forms of sugars more or less closely 
related, and at the present time largely manufactured from starch by the 
action of sulfuric acid. Glucose is a very readily digested food, being 
sweet, and possessing the advantages of ready solubility and agreeable \ 
taste. It is not as sweet as cane-sugar, and some of the commercial forms, 
because of slovenly methods of manufacture, contain traces of acid and 
other impurities. For the most part, however, glucose is a perfectly harm¬ 
less article, and not the vile adulterant that is harped upon by hysterical 
food reformers. 

GLYCERIN.— A sweet, soluble liquid, obtained from fats and fixed 
oils by the action of caustics. It is most frequently obtained as a by¬ 
product in the manufacture of soaps. Pure glycerin should be colorless 
and odorless, extremely viscid, hygroscopic, and sweet to the taste. Ex¬ 
posed to the air it absorbs moisture, and applied to the skin abstracts water 
from the tissues. Taken internally it slightly irritates the stomach and 






Glycyrrhiza 

Gonorrhea 


THE STANDARD FAMILY PHYSICIAN 


364 


intestines, causing diarrhea; and used in the form of suppositories it may 
be useful in relieving constipation. Solutions of glycerin and water with the 
addition of alcohol and various aromatics are widely employed as applica¬ 
tions to the mouth and lips, especially in conditions of fever. The excessive 
use of glycerin leads to chapped hands, cracked lips, and much discomfort, as 
it has the property of absorbing water from the mucous membranes, leaving 
these structures cracked and irregular. Medicinal preparations made with 
glycerin are termed glycerites. 

GLYCYRRHIZA (LICORICE). —The dried root of Glycyrrhiza glabra 
and other species of Glycyrrhiza , shrubs native to southern Europe, south¬ 
western Asia, Persia, and surrounding countries. The greater portion of 
the licorice imported into the United States is the so-called Spanish licorice. 
Licorice contains a small percentage of volatile oil, and large quantities of 
sugar, gum, and woody residue. It has a peculiar characteristic taste, and 
is extensively used to disguise the flavor of other remedies. Of itself it has 
very little action. It is thought to give a mild laxative effect, but com¬ 
pound licorice powder, in which it is used in large quantities, is laxative 
because of the senna it contains rather than because of the licorice. Large 
quantities of the ordinary licorice are laxative because of the sugar contained 
in this confection. 

GOITER. —An enlargement of the thyroid gland, which is situated in 
the front part of the throat, immediately below the larynx (see Plate IV. 19). 

Large goiters are greatly disfigur¬ 
ing because of their exposed posi¬ 
tion (see Fig. 144). This, however, 
is not the only disadvantage of the 
condition. Many patients afflicted 
with goiter suffer from shortness of 
breath; • they are unable to lie flat 
on their back in bed; and rapid 
walking and climbing of stairs is 
disagreeable to them. In many 
cases attacks of suffocation may oc¬ 
cur. The presence of goiters con¬ 
stitutes a single symptom only in 
certain diseases, as in Exophthal¬ 
mic Goiter (which see). Other 

goiters may become malignant; as, 
for instance, in cancer of the thyroid gland. 

In mild cases, and in those accompanied by only slight disturbance, 
goiter is treated with inunctions and internal remedies. If the goiter causes 
serious disturbances, or if it is very disfiguring, operative removal is indi¬ 
cated. Its removal is imperative if it is cancerous. The operation for the 



Fig. 144. Goiter. 










365 


Glycyrrhiza 

Gonorrhea 


THE STANDARD FAMILY PHYSICIAN 

removal of goiter was formerly considered very dangerous. At the present 
time, however, owing to the refinements in technic, it is a comparatively 
safe procedure. It can be designated as dangerous only in exophthalmic 
goiter, and in cancer. In both cases, however, the danger is because of the 
disease, and not by reason of the operation. The operator should never 
remove the entire thyroid gland, but should always allow a portion to 
remain intact; for experience has taught that the entire gland can not be 
spared by the body. If it is completely removed, a condition develops 
which will be found described in detail in the article Thyroid Gland, 
Diseases of. 

GONORRHEA. —Contagious catarrh of the urethra; vulgarly called 
“clap.” This is a very wide-spread disease, a “disease of the masses,” 
which is found among an alarming number of patients, especially among 
the youths of large cities. It is not an exaggeration to state that the public 
and private prostitutes of a great city are almost without exception thus 
infected. It is greatly to be regretted that many of the young men suffering 
from gonorrhea are never thoroughly cured, because of inadequate treat¬ 
ment of the first, or of subsequent attacks. It sometimes happens that 
this disease develops with barely any accompanying symptoms, or at least 
without much annoyance to the patient. The disease may exist in a latent 
condition for years, the patient meanwhile considering himself perfectly 
well. These latent forms of gonorrhea in young men are a grave social 
danger, for they are the means of spreading the contagion further and 
further, and sad experience teaches that thousands upon thousands of 
young, innocent women become infected by their husbands. 

In women the disease runs a very slow course, is difficult to recognize 
in its early stages, and shows a tendency to attack the internal female 
sexual organs and their neighboring parts. These inflammatory abdom¬ 
inal conditions may cause serious impairment of the general health, and 
influence the power of conception. Furthermore, in most cases gonorrhea 
in women must be regarded as incurable, or removable only by energetic, 
dangerous operations (castration) which often cause sterility. All these 
results make it to be earnestly hoped that finally the public in general will 
learn to appreciate more fully the dangers arising from gonorrhea, not only 
for the individual, but for the public at large as well; and that instead of 
regarding the victims as targets for cheap wit, they will be considered as 
subjects greatly in need of medical attendance. As in syphilis, individual 
and general modes of prevention must be directed toward a reduction in the 
number of infected persons; a result which can be achieved only when the 
prevalent ideas of sexual conditions have become thoroughly changed. 
Such a change can only take place if the prudery and false morality of the 
day is overcome, and makes way for the fundamental principles of true 
humanity. 





Gonorrhea 


THE STANDARD FAMILY PHYSICIAN 


366 


Gonorrhea appears differently in the two sexes. In the male it generally 
manifests itself after several hours or a few days by a pricking sensation in 
the end of the penis. The urine burns as it passes out, and is later followed 
by a thin, fluid secretion which gradually turns purulent. This pus may 
at first be scanty, or it may be very profuse. Urination becomes more and 
more painful, as does also erection. The latter condition is often accom¬ 
panied by considerable swelling of the meatus of the urethra, at times of 
the entire organ, or of the glans and foreskin. These painful inflamma¬ 
tions become more severe and persist at a certain height until the third 
week; then the discharge again becomes gradually mucopurulent, then 
mucoid, and soon disappears entirely. In an uninterrupted cure, the dis¬ 
ease is conquered usually in six to eight weeks. If the disease, as often 
happens, is insidious, there remains a scant secretion of mucus for weeks, 
months, and even years. These lasting mucous discharges may be conta¬ 
gious, but are not always so. This point can be decided by the physician 
only after repeated microscopical examinations of the discharges or of the 
“threads,” found especially in the morning urine. A material delay in the 
cure, and a change of prognosis regarding the issue, is conditioned by a 
number of possible accidents. The most usual complications are: Inflam¬ 
mation of the epididymis (see Epididymitis); inflammation of one or 
both testicles, at times causing the affected testicles to become functionless 
(see Orchitis); inflammation of the lymphatic glands and the lymph- 
channels (see Bubo); inflammation of the prostate (see Prostatitis); 
and inflammation of the neck of the bladder or of the bladder itself (see 
Cystitis). Late consequences of an insidious gonorrhea are contractions 
of the urethra (see Stricture) and, in rare cases, the spread of the infec¬ 
tion to internal organs. Inflammation of the iris, and gonorrheal rheuma¬ 
tism may be mentioned as possible results of such infection. The results 
may be very dangerous, conditioned by the importance of the organ affected. 
In all cases, any additional disease which may occur will cause consider¬ 
able delay in the cure. 

In the female there are fewer urinary symptoms, unless by chance the 
disease invades the urethra. The discharge (at first scanty, but gradually 
increasing in quantity) is usually regarded as a harmless leucorrhea; and 
not until the disease has progressed upward to the internal sexual parts 
does a copious mucous discharge appear. Usually the disease progresses 
from the womb to the tubes and ovaries. Then collections of pus take 
place in the tubes, with limited peritoneal exudations and adhesions; and 
these in turn cause lasting inflammatory conditions which can be cured only 
by operation. The insignificance of the early symptoms, and the absolute 
ignorance of many women of the possibility of such a disease, readily 
explain the delay in treatment; and it generally requires some persuasion 
to influence a girl or a woman to submit to an examination. Whenever 




THE STANDARD FAMILY PHYSICIAN 


Gonorrhea 


367 


symptoms of a mucous or purulent discharge from the vagina, difficulty in 
urination, or pains in the abdomen, occur shortly after marriage, it is advis¬ 
able that a thorough examination be made, and that attention be paid to 
the possibility of gonorrhea being present. The husband should be exam¬ 
ined also, especially if he had suffered from gonorrhea before marriage. 
The sooner the treatment is begun (of both parties, if necessary), the more 
lasting will be the results obtained. With women, as with men, complica¬ 
tions are common. Cystitis, vaginitis, and cervical erosions are not unusual. 
In women the contagious inflammation frequently comes in contact with the 
vaginal discharge, spreads to the anus, and causes gonorrhea of the rectum. 
In such cases evacuation of the bowels becomes exceedingly painful. 

The eye is always endangered by contact with gonorrheal discharge. 
The purulent inflammation which results is always very severe, and may 
lead to total destruction of the eye (see Eye, Diseases of). It is there¬ 
fore necessary that persons suffering from gonorrhea should wash the hands 
most scrupulously after treating the parts (injections, etc.), and avoid every 
possibility of the eye coming in contact with the discharge (from soiled linen 
or bandages). Contagion is produced most frequently by sexual intercourse. 
There are, however, cases of non-sexual contagion. Sponges, soiled wash, 
and towels may convey a gonorrhea to little girls. 

For the prevention of contagion, stress must be laid on the importance 
of great cleanliness both before and after coition. In addition, the use of a 
condom is advisable; this is an artificial protective which, if of good quality 
and properly applied, will protect the sexual parts of both persons. As an 
additional protection for young men from contagions resulting from pros¬ 
titution, some drops of a two per cent, solution of nitrate of silver may be 
instilled into the opening of the urethra immediately after intercourse. 

As to the treatment, it may be said that after the first twelve to twenty- 
four hours, washing out the anterior urethra with bactericidal remedies (to 
be done only by a physician) is at times efficacious in preventing an out¬ 
break of the disease. Later this treatment is of no value, and the condition 
must then be handled according to the severity of the inflammation. Ther¬ 
apeutic treatment lies entirely in the hands of the physician; it is very 
unwise to try the remedies used by another person, for there is no one cure 
for all cases, and medical treatment is conditioned by the symptoms in each 
case. It is imperative that a patient suffering from gonorrhea should 
adopt a sensible mode of life, and avoid bodily exertion, sexual excitement, 
and alcoholic drinks. Carelessness in this regard is just as wrong as preju¬ 
dice against medical treatment (particularly injections), for the latter natu¬ 
rally aids the progress of the cure. The fear that the suppression of the 
urethral discharge caused by the injections may lead to internal diseases, 
must be rejected, as it is based upon wrong impressions. It goes without 
saying that quacks should not be allowed to treat such a serious disease 





Gonorrhea 

Gout 


THE STANDARD FAMILY PHYSICIAN 


368 


Such persons generally regard the patient as an object of profit rather than 
some one needing careful treatment. Young men are ruined for life by 
quacks. Some quacks have been known to cause gonorrhea to last for a 

long time. 

The wide-spread view that gonorrhea may be caused by intercourse with 
a woman who has leucorrhea, is erroneous; as is also the belief that it can 


be caused by intercourse during, or immediately before or after, menstrua¬ 
tion. Another wide-spread, remarkable belief, that gonorrhea may be 
cured by intercourse with a virgin, or with a pregnant woman, is nothing 


Fig. 145. The bacteria (gonococci) which cause gonorrhea. 



less than criminal. It is hardly necessary to oppose such a ridiculous 
superstition; it suffices to recognize it as such, and to call attention to the 
dangers which result from such a belief. 

The opinion expressed by certain “nature doctors,” that in gonorrhea 
the inflammation primarily localizes itself just posterior to the glans, is 
quite correct, inasmuch as the first seat of the disease is in the anterior part 
of the male urethra. But the belief, that in consequence of injections 
(which according to “nature doctors” is an incorrect treatment) the disease 
spreads over the entire urethra, is incorrect. The condition will spread 
when this mode of treatment has failed to suppress it at the very beginning. 
This is the natural course of the disease, which no method or “nature cure” 
can change. The seemingly brilliant results that some quacks achieve 
with various methods, whether injections play a part or not, is explained in 














369 


THE STANDARD FAMILY PHYSICIAN 


Gonorrhea 

Gout 


the following way: There are many persons who suffer from latent gonor¬ 
rhea, and whose condition is now and then aggravated by certain harmful 
proceedings, such as sexual irritation, and overindulgence in alcoholic 
drinks. The symptoms of this condition will naturally disappear with a more 
careful way of living. Such cases, though far from being cured, are looked 
upon as cured, and pronounced as such, by persons who have no knowledge 
of these conditions. Herein also lies a refutation of the supposition always 
brought forward by quacks and “nature doctors,” that men may acquire 
gonorrhea in intercourse with absolutely healthy women. Such are like¬ 
wise cases of latent gonorrhea, but by claiming the infection to have come 
from a woman, well known to be healthy, the affected person puts a load off 
his conscience. (The bacteria which cause gonorrhea are known as Gon¬ 
ococci; see Fig. 145.) 

GOSSYPIUM (COTTON-ROOT). —The bark of the cotton-root is used 
extensively in the southern states, particularly by the negroes, because of 
its effect in stimulating the intestines and uterus. Much of the extract of 
cotton-root bark is inactive, which has led to the idea that the root contains 
no medicinal principle; but fresh specimens show a marked stimulating 
action on the uterus. 

GOUT. —A disease of nutrition. Its causes are not all known, and there 
is much uncertainty about what is known; but there is usually an excess of 
uric acid bodies (purin bases) circulating in the blood, and attacks of inflam¬ 
mation in the small joints occur with general constitutional disturbances. 
Uric acid and its combinations (purin bodies) represent, as it were, a por¬ 
tion of the ashes which result from the breaking down of the proteids of the 
body or of the food. Under normal conditions these are excreted from the 
body through the kidneys, as urea, and uric acid, etc.; in smaller quanti¬ 
ties also through the sweat-glands. Proteid (albumen) is ingested with the 
food; as with meat, fish, eggs, cheese, milk, bread, and legumes. The in¬ 
gested proteid is necessary to replace that constantly being used by the 
body in the heart-beat, and in the acts of walking, thinking, talking, etc. 
Circulating in the blood, the proteids are burned, in contact with oxygen, 
and they are thus partly the source of the energy of the living body. It has 
been held that so long as the one product of metabolism, uric acid, is excreted 
regularly and in sufficient quantities, it is impossible to become affected by 
gout. This, however, is only part of the truth; not all. 

The defect may be twofold : either the proteids are not properly oxidized; 
or perhaps the fault is in the elimination. Thus, if the quantity of uric acid 
bodies present in the blood increases, or if their excretion becomes faulty, 
these salts begin to precipitate in the different tissues, cartilages, and organs. 
If the deposits occur at the surface of the body, they form the well-known 
gout-stones. These are found, among other places, in the cartilages of the 
ear, in the joints of the fingers, and with special predilection in the joint of 





Gout 

Growth 


THE STANDARD FAMILY PHYSICIAN 


370 


the great toe {podagra). These deposits may give rise to severe pains, and, 
probably because of mechanical reasons, they generally lead to violent 
inflammations; or they may give rise to no such manifestations, the appear¬ 
ance of gout-stones being the only warning given. Just as the deposits 
occur externally, so they may take place in the interior of the body, where, 
according to their location, they cause various disease symptoms. For 
instance, many an attack of tracheal catarrh or of migraine may be due 
solely to these deposits. That variations in proteid metabolism cause the 
various forms of gout is practically all that is known with certainty regarding 
these morbid processes. 

However insufficient the positive knowledge may be concerning this 
disease, the statements made will convince even the layman that it is neces¬ 
sary to diminish the ingestion of all foodstuffs which contain proteids. This, 
of course, does not take cognizance of what is probably of most importance: 
that the defect is one of the body, and not due to any excess of food. Thus, 
the older school of physicians insisted that all proteid diet be excluded in 
the very severe cases, allowing only milk in small amounts. Alcohol is 
subject to the same exclusion. It has been acsertained beyond doubt that 
alcoholic liquors favor attacks of gout; indeed that gout may be the unpleas¬ 
ant receipt for sins committed by the abuse of alcoholic drinks. It there¬ 
fore becomes the indispensable duty of the patient to abstain from alcohol, 
and to quench his thirst by drinking fruit-juices and lemonades in place of 
beer and wine, as may have been his custom previously. The effects of 
alcohol in this disease are difficult of explanation, and offer a serious obstacle 
to the acceptance of the “uric acid theory.” 

As to the diet, fruits are allowable. They may be combined with vege¬ 
tables, such as potatoes, radishes, and lettuce; the last-named, however 
should preferably be prepared with lemon-juice. The food should be only 
moderately seasoned and spiced, and the patient will surely find out that 
it is to his own advantage if he observes a general moderation in eating. It 
is probably beyond question that an exaggerated enjoyment of the products 
of the culinary art favors the development of gout, if for no other reason 
than for the increased ingestion of proteid substances. 

It should not be forgotten that the poor also may be affected by gout. 
Heredity is an important factor, and the children of gouty parents should 
be careful in their mode of living, particularly with reference to alcoholic 
drinks, poit, and malted liquors. The following requirements, which must 
be met in oidei to prevent the occurrence of gout, are commendable also for 
other reasons,'and are not difficult to carry out. (i) A great deal of fruits 
should be eaten every day, and moderation should be observed in the use 
of fish, meat, cheese, etc. (2) Plenty of daily physical exercise should be 
taken, such as walking, gymnastics, etc. (3) Alcoholic drinks should be 
used with great caution. As a rule, most people eat too much meat and get 



371 


THE STANDARD FAMILY PHYSICIAN 


Gout 

Growth 


far too little exercise. It is therefore not astonishing that the overabundant 
and surfeited blood, together with inactive metabolism, lead to morbid 
manifestations; and that exaggeration on the one hand and neglect on the 
other bring about their sad consequences. The occurrence of gout in con¬ 
sequence of chronic lead-poisoning is of greater interest to the physician 
than to the layman. 

GRANATUM. —See Pomegranate. 

GRAPE-CURE. —The great amount of sugar present in southern grapes 
makes them, in sensible combination with other articles of nourishment, 
a splendid food for patients who are anemic, weak, or convalescent. This 
cure is especially indicated for cases in which it is desirable to obtain the 
effect of the watery constituent of the grapes, and of their acids. In cases 
of hemorrhoidal and digestive disturbances grapes are often more curative, 
and certainly more pleasant, than mineral waters. The patient should eat 
about five pounds of grapes daily, not more; and this quantity should be 
divided so that one half is taken in the morning before breakfast, and the 
other half in two or three portions during the day. The skins and stones 
must not be swallowed. While taking a grape-cure, the patient should 
avoid acid or fatty foods, beer, rye-bread, etc. 

GRAVES’ DISEASE. — See Exophthalmic Goiter. 

GRAY HAIR. —See Hair, Care of. 

GRINDELIA. —The dried leaves and flowering tops of Grindelia robusta, 
a plant native to the western portion of the United States, and introduced 
into medicine as a mild bitter, a tonic, and an expectorant. It has a distinct 
action in diminishing the spasmodic activity of the bronchi, and has been 
of use in the treatment of whooping-cough and subacute bronchitis. 

GRIPPE. —See Influenza. 

GROWTH. —The gradual development to maturity. It has always been 
customary to divide the life of man into seven ages of seven years each. 
Childhood includes the first seven years; puberty brings us to the four¬ 
teenth year; and at the age of twenty-one man has left youth behind him 
and has arrived at the end of his growth. These three periods are so char¬ 
acteristic and so marked, that even Roman legislation took them into con¬ 
sideration. Also the later periods are noteworthy. At forty-two man has 
reached the middle of life, and from this time, although the mental faculties 
may continue to develop, the bodily strength gradually declines. In 
women fertility ceases. The seventieth year may be consideied the begin¬ 
ning of the senile period. Naturally there are exceptions. In many cases 
it may not be said to have set in even at this time, but as a iulc it commences 
at a much earlier period. 

Of greatest importance are the first three periods. By the seventh year 
the actual growth of the brain is practically completed, and thenceforth it 
merely becomes more and more perfect in development. The dentition 




Guaiac 

Gymnastics 


THE STANDARD FAMILY PHYSICIAN 


372 


also undergoes a change about this time, and may result in a variety of nerv¬ 
ous disturbances. Puberty is manifested about the fourteenth year, coming 
on somewhat earlier in girls than in boys, and is marked by a growth of hair 
on the chin, the pubes, and the axillae, and by the appearance of menstru¬ 
ation in the female and the discharge of semen in the male. Nervous 
disturbances may set in during the period of sexual development. The 
change which takes place in the voice at the time of puberty is especially 
marked in boys. The larynx grows and the vocal cords increase with about 
one-third of their original length. The laryngeal muscles, however, do not 
keep pace with this rapid growth; and as a result the loss of complete 
control brings about the sudden changes in speech which are recognized as 
a “cracked voice.” Restoration takes place slowly, and during this time 
all attempts at singing should be avoided. The twenty-first year finally 
marks the completion, and the attainment of full physical growth. 

GUAIAC.—The heart-wood of Guaiacum officinale, obtained from small 
trees of Central and South America and the West Indies. Its chief con¬ 
stituents are resinous principles of undetermined composition. Guaiac has 
been extensively used in the treatment of blood disorders, but has fallen out 
of favor for these diseases. It has a certain vogue in the treatment of ton¬ 
sillitis, but its use in medicine is diminishing rapidly. It is very serviceable 
in a chemical test for the detection of blood in human secretions. 

GUAIACOL.—One of the chief constituents of creosote, from which 
substance it differs but slightly in its action. It is not as irritating, 
however, and has not such a persistent taste nor odor. It is used 
in much the same manner and for the same purposes as Creosote (which 
see). 

GUARANA.—This is a dried paste, obtained from the crushed seeds of 
Paullinia cupana , a plant native to Brazil and contiguous countries. 
Guarana contains at least five per cent, caffein, and is extensively employed 
as a drink for much the same purposes as tea and coffee. It also contains 
tannic acid, wherefore it combines astringent properties with the stimu¬ 
lating qualities due to the caffein. 

GUINEA-WORM.—See Filaria. 

GULLET, DISEASES OF.—See Esophagus, Diseases of. 

GYMNASTICS.—A form of exercise which tends to give the body a 
uniform development. It is usually taught in gymnasiums or on gym¬ 
nastic grounds, for the majority of the exercises require special apparatus 
which make the exercises more varied and more difficult to execute. If 
properly selected, these exercises will always accomplish the desired result: 
the uniform development of the body. Gymnastic exercises may be taken 
in summer as well as in winter, and in all kinds of weather. As a con¬ 
tinuous pursuit they are therefore to be preferred to any other form of 
bodily exercise. They are especially valuable for persons who follow 




373 


Guaiac 

Gymnastics 


THE STANDARD FAMILY PHYSICIAN 


sedentary occupations, and who have but little leisure, and not much 
money to spend on recreation. 

Grown persons who practise gymnastics for the first time, or after a 
long inten al, should begin with very easy exercises in order to avoid 
exhaustion, pain in the limbs, and increased body temperature. This 
condition, however, is by no means dangerous, and generally subsides 
after a few days. The feverish condition which sometimes follows vig¬ 
orous gymnastic exercises is due to the circumstance that the lactic acid 
produced by the muscle activity is not thrown off by the body in sufficient 


Fig. 146. Bending the head Fig. 147. Inclining the head to the 

forward and backward. right and left alternately. 

quantity. After the exercises have been performed a few times the circu¬ 
lation of the blood becomes more vigorous, and rise in temperature does not 
reappear. In children whose circulation is otherwise undisturbed no rise in 
temperature will result from the gymnastic exercises. 

I. Curative Gymnastics.—Under this name are included a number of 
systematically arranged bodily exercises wdiich should be undertaken by 
patients to improve or to cure existing ailments; or by the healthy to exert 
a favorable influence upon temporary conditions which, although not mor¬ 
bid in character, make special demands upon the body (as for instance, 
during pregnancy). Some of these exercises can be practised by the patients 
alone; others only with the assistance of another person, or with special 
apparatus and machines. According to their different forms, the exercises 
are classified as Nerve Gymnastics , Swedish Gymnastics , Respiration Gym¬ 
nastics , Orthopedic Gymnastics , and Home Gymnastics. The last-named 
exercises form a transition to the gymnastics of the healthy, as they are prac- 























Gymnastics THE STANDARD FAMILA PHYSICIAN 


tised, not by the diseased only, but by healthy individuals who wish to pre¬ 
vent a weakening of the body, but who have neither the inclination nor the 
opportunity to practise any other form of physical exercise. Curative g>m- 
nastics are often recommended to patients in order to assist in other cures. 
It is not advisable for a patient, however, to practise these exercises until 
the latter half of the period of convalescence, when he has recovered a cer¬ 
tain degree of his strength. Since curative gymnastics are perfected to the 
smallest details, they should be prescribed by the physician according to a 
well-conceived plan, adapted to the requirements of each indi\idual patient. 




Fig. 148. Rotary movement of the head. 


Fig. 149. Turning the head. 


Before undertaking gymnastic exercises it is necessary to observe a num¬ 
ber of instructions. In the first place, it is important to select the proper 
time of the day. As one daily exercise is sufficient, it is best to select the 
late forenoon. The early morning, immediately after rising, should be 
used only by strong persons. If it is desired to repeat the exercises, the late 
afternoon hours should be selected for this purpose. Many individuals who 
suffer from insomnia are fond of practising gymnastic exercises shortly 
before retiring. The times recommended prevent conflict with the meal 
hours; for it is a very old rule that no gymnastic exercises should be per¬ 
formed until one or two hours after a hearty meal. There is no harm, 
however, in taking a light lunch, a cup of bouillon or tea, before an exercise. 
It is obvious that comfortable clothing should be worn, and that all tight 
and close-fitting garments should be removed (the corset by women; the 
starched shirt by men). The patient must avoid physical and mental 
exertions immediately before practising. Absolute rest of the mind must 




























375 


THE STANDARD FAMILY PHYSICIAN 


Gymnastics 


be insisted upon also during the exercises. Conversation or reading during 
the intervals is prohibited. 

. After the exercises it is desirable that the patient rest for some length of 
time; weak patients should lie down for half an hour. No meal should be 
taken until half an hour or an hour after. The regular practise of the 
gymnastic exercises is of importance. During the entire time of the cure 
the patient is not permitted to undergo any great exertions, nor to keep late 
hours. The hour of the day decided upon for the exercises must be strictly 
adhered to. At the beginning the physician will explain to the patient that 




Fig. 150. Raising the arms forward. Fig. 151. Raising the arms laterally. 

a material improvement can not be noticed until a month has passed, and 
that only perseverance and endurance will lead to the desired end. 

For healthy persons, or for those who are but slightly indisposed, and 
to whom the physician leaves the selection of the gymnastics, the following 
suitable house exercises are of value. 

Movements of the Head.—These are advisable only for the young; older 
people are liable to become affected with vertigo by practising them. 

(1) Bending the head forward and backward (Fig. 146).—The head is 
bent forward slowly (not by jerks) until the chin eventually touches the 
chest. After remaining in this position for a few moments, the head is 
brought back into the upright attitude. The upper part of the body, 
especially the shoulders, should not participate in this movement; this 
applies particularly to the trunk, which must be kept quite straight. When 
bending the head backward, which is performed in the same manner, one 
should not attempt to speak or swallow. It is best to hold the breath. 






































Gymnastics THE STANDARD FAMILY PHYSICIAN 


(2) Inclining the head to the left and to the right (Fig. 147)- This 
exercise is performed in the same manner as the preceding, only that the 
head is bent sideways instead of forward and backward. A combination 
of these four movements results in the next exercise. 

(3) The rotary movement of the head (Fig. 148). The movement is 
made alternately toward the right and toward the left. The circle is de¬ 
scribed by first bending the head forward and then, without raising the face, 
turning it toward the right laterally until the cheek touches the shoulder; 
the movement continues backward and toward the left until the left cheek 



Fig. 152. Bending the arms. 


Fig. 153. How to grasp the wand. 


touches the left shoulder, when the head is again brought forward to the 
first position. The circle is then repeated toward the left side in a similar 
manner. The attitude of the trunk should be exactly as in exercise 1. 

(4) Turning the head (Fig. 149).—While keeping the body erect, the 
head is turned toward the left and right alternately, in such a manner that 
the chin almost touches the front part of the shoulder. 

The exercises mentioned thus far are rendered possible by the rotation 
of the first cervical vertebra, the atlas (see p. 31). It is practical in these 
four exercises to place the hands upon the hips. After each of these move¬ 
ments has been practised from two to six times, about five deep inspirations 
should be made. These exercises of the head strengthen the muscles of 
the neck and of the nape, and the joints of the cervical vertebrae become 
more free and movable. If there is weakness or partial paralysis of these 
muscles, combined with habitual faulty attitudes of the head (for instance, 



















377 


THE STANDARD FAMILY PHYSICIAN 


Gymnastics 


inclination of the head to one side), these exercises are advisable, and should 
be made to one or to both sides as the case may require. 

Movements of the Shoulder-girdle and of the Arms.— A number of 
exercises belonging under this category will be found in the paragraphs on 
Respiratory Gymnastics (see Figs. 191-198). 

(1) Raising the arms forward, with or without clenched hands.—In the 
original attitude the arms hang down. From this attitude they are stretched 
and raised forward during inspiration, held for a few seconds in the position 




Fig. 154. Upward stretching of wand. Fig. 155. Turning the wand above the head. 

shown in Fig. 150, and then lowered during expiration. The exercise may 
be repeated from three to fifteen times. 

(2) Raising the arms laterally, with or without clenched hands (Fig. 
151).—This exercise is executed in the same manner as the preceding one, 
and may likewise be repeated from three to fifteen times. 

(3) Raising the arms, with or without the hands clenched (compare Fig. 
193).—Inspiration should be made on raising, expiration on lowering the 
arms. The method of practise is as in the two previous exercises. This 
should be repeated from two to ten times. 

(4) Bending the arms, with or without clenched hands (Fig. 152).— 
The suspended arms are bent at the elbow-joint, and then brought upward 
in front of the shoulders or breast, the patient making an inspiration at the 
same time. After remaining in this position for a few seconds, the arms 
are lowered into the original attitude, with simultaneous expiration. This 
exercise is to be repeated from three to fifteen times. 




















Gymnastics 


THE STANDARD FAMILY PHYSICIAN 


378 


(5) Thrusting the arms forward.—This exercise may be done (a) 
either alternately, or (b) with both arms simultaneously (compare Fig. 
196); or it may be made (c) by alternately bending the left arm and thrust¬ 
ing forth the right, and thrusting forth the left and bending the right. Exer¬ 
cise a should be practised ten times; b, six times; c, four times. From the 
attitude in Fig. 152, the arms are stretched by being thrust forward, either 
singly or simultaneously, during the act of expiration; this position is held 
for a few seconds, when the original posture is again assumed by bending 
the arms during inspiration. 

(6-8) Thrusting the arms sideways (6), upward (7), downward and 
backward (8).—To be executed as exercise 5. Inspiration is necessary 




Fig. 156. Lowering the wand backward. 


Fig. 157. Lowering the wand backward, 
stretching the arms. 


when thrusting the arms sideways and upward; expiration when bending 
them. In exercise 8, however, expiration must accompany the thrust; 
inspiration, the act of bending. 

Exercises with the Wand.—The original attitude (9) is shown in Fig. 
153. The wand should be grasped so that it can be held comfortably in 
front of the body. 

(10) Bending the arms with wand in front of the chest (compare Fig. 
152).—The wand is held in this position for a few seconds, and is then 
again lowered. To be repeated from ten to twenty times. 

(n) Upward stretching of the wand (Fig. 154).—This attitude may 
be assumed either by thrusting the wand vertically upward after having 
selected exercise 10 as original position; or, beginning with the attitude 





















379 


THE STANDARD FAMILY PHYSICIAN 


Gymnastics 


shown in Fig. 153, by raising the wand with the arms stretched, first for¬ 
ward and then upward. Inspiration must be made during the upward 

movement, expiration to follow during the re¬ 
turn into the original attitude chosen. Repeat 
from six to twelve times. 

(12) Twisting the wand over the head.— 
This exercise is commenced by stretching the 
wand upward as in No. n, during the act of 
inspiration; from the attitude in Fig. 154, the 
wand passes into that shown in Fig. 155 by 
crossing the arms over the head and twisting 
the wand in the horizontal plane, grasping it 
quite loosely and with the hands a little closer 
together than shown in Fig. 154; this is fol¬ 
lowed by an expiration. After remaining for 
several seconds in this position, the attitude 
in Fig. 154 is resumed during an inspiration; 
whereupon the wand is returned to the orig¬ 
inal attitude selected. Four to eight times. 

(13) Lowering the wand backward, down 
to the nape of the neck.—Begin with exercise 
9; follow this up with exercise n (Fig. 154); 

and then lower the wand behind the head until it rests upon the nape of 
the neck (Fig. 156), these movements to be 
accompanied with an expiration. Take an 
inspiration while stretching the wand upward, 
and then return to the original attitude during 
expiration. Six to eight times. 

(14) Lowering the wand backward, with 
stretching of the arms.—From the attitude in 
Fig. 154 the wand is lowered behind the head 
until attitude 156 is reached; whereupon both 
arms are brought almost simultaneously into 
the attitude represented in Fig. 157 by thrust¬ 
ing both arms downward in rapid succession. 

This movement is made during expiration, 
inspiration taking place during the return into 
the original attitude (Fig. 154)- Three to eight 
times. 

(15) Swinging the wand to the side. 

From the horizontal position (Fig. 153) the 
wand is swung into the vertical attitude on the left side of the body (Fig. 
138) the right arm being bent transversely in fiont of the body, and the 




























Gymnastics 


THE STANDARD FAMILY PHYSICIAN 


380 



Fig. 160. Bending the hand backward 
and forward. 


Fig. i6i. Exercise for the palm 
of the hand. 



Fig. 162. Exercise for the palm 
of the hand. 


Figs. 163, 164. Finger exercises. 



I 


Figs. 165, 166. Finger exercises. 

















381 


THE STANDARD FAMILY PHYSICIAN 


Gymnastics 



Fig. 167. Bending the trunk 
forward. 


Fig. 168. Straddle position, with hands 
resting on hips. 



Fig. T69. Bending the trunk 
backward with raised arms. 


Fig. 170. Bending the trunk sideways, 





















Gymnastics 


the standard family physician 


382 


left arm stretched upward. From this attitude the wand is again stretched 
into the horizontal position, whereupon it is swung into the vertical attitude 
on the right side. Inspiration should take place during the raising of the 
wand. Eight to twelve times. 

(16) Lowering the wand to the side (Fig. 159).—The wand is raised 
high as shown in Fig. 154* and then lowered to the left side so that the right 
arm is bent over the head, and the left arm extended downward. Then the 
wand is again stretched upward, and lowered to the vertical position on the 



Fig. i7i. Rotary movement of the trunk. 


Fig. 172. Turning the trunk, the 
arms being extended. 


other side. Both exercises should be made alternately about four to eight 
times. 

The sixteen exercises described in the foregoing tend to strengthen the 
muscles of the chest, of the arms, and of the back. They exert a favorable 
influence upon respiration, and therefore indirectly upon the heart. They 
are especially indicated in persons with flat or weak chests, with faulty atti¬ 
tude of the body, and with lateral curvature of the spinal column. 

Exercises of the Hands and Fingers.—Hand and finger exercises, of which 
only a few illustrations are given, are indicated for patients with cold fingers. 
They are especially applicable in writer’s cramp. 

(1) Bending the hand backward and forward (Fig. 160).—This exercise 
should be repeated from six to ten times. Weak patients should support 
the forearm during the exercise so that the hand preserves its freedom of 
motion; stronger patients hold the arm unsupported, either extended or 
bent. 

(2-3) Exercises for the palm of the hand.—Figs. 161 and 162 illustrate 














383 


THE STANDARD FAMILY PHYSICIAN 


Gymnastics 



Fig. 173. Raising the legs sidewise. 


Fig. 175. Raising the legs backward. 



Fig. 174. Raising the legs forward. Fig. 176. Rotary movement of thigh. 


























Gymnastics 


THE STANDARD FAMILY PHYSICIAN 


384 


how to perform these movements. No. 2 (Fig. 161) should be made from 
three to ten times; No. 3 (Fig. 162), five to fifteen times. 

(4-7) Finger exercises.—The various finger movements are illustrated 
in Figs. 163—166. The exercise shown in Fig. 163 should be made three to 
ten times; that of Fig. 165, five to fifteen times; that of Fig. 164, three to 
ten times; and that shown in Fig. 166, five to twenty times. 

Movements of the Trunk. —These movements are executed principally 
by the raising and lowering of the pelvic girdle, with participation of the 
spinal column. 

(1) Bending the trunk forward.—This may be done either with the 
hands resting on the hips, or with forward swinging of both arms, as if 



Fig. 177. Raising the knee. 



Fig. 178. Stretching the leg. 


intending to support the hands upon the floor (Fig. 167). In these exer¬ 
cises it is best to spread the feet apart in straddle fashion (see Fig. 168). 
Expiration should accompany the bending; inspiration, the straightening 
of the body. Repeat from three to eight times. 

(2) Bending the trunk backward, swinging the arms upward and back¬ 
ward (Fig. 169).—This exercise may be repeated from three to eight times; 
it is best to hold the breath while performing the movements. 

(3) A combination exercise.— Exercises 1 and 2 are practised alter¬ 
nately in such a manner that the movements resemble those made in chop¬ 
ping wood. Two to six times. 

(4) Bending the trunk sideways.—This is done to the right and left 
alternately, while supporting the hands upon the hips (Fig. 170). Six to 
twelve times. 


















385 


THE STANDARD FAMILY PHYSICIAN 


Gymnastics 


(5) Rotary movement of the trunk.—This is a combination of the four 
pievious exercises. It is best to begin with the arms raised; from this 
attitude the rotary movements are executed by bending the trunk to the 
left, and then go through the same movements to the right, letting the arms 
participate in the rotation (Fig. 171)* Two to six times. 

After having practised these five exercises the patient should pause, 
place his hands upon the hips and, with closed mouth, take four to ten deep 
inspirations and expirations. 

(6) Turning the trunk to the left and to the right.—With the upper 
part of the body erect, the trunk is turned around its up and down axis. 
The exercise can be facilitated by raising the extended arms forward (see 




Fig. 179. Raising the lower leg. Fig. 180. Bending and extending the foot. 

Fig. 150), and letting them participate in the turning movement (Fig. 
172). After a brief stay in the turned position to the left side, the arms are 
turned back, following the same movements to the right side. Four to ten 
times. 

The six trunk exercises here described are suitable for everybody. They 
are indicated especially in disturbances of the circulation of the blood in the 
abdomen, and in cases of constipation. Hence, they can be recommended 
to women and girls. 

Rotary Movements of the Pelvis and Legs. —All the exercises mentioned 
under this heading strengthen the muscles of the pelvis and of the legs. 
They are not of much use in persons who are up and about practising these 
muscles by their daily exercise; but they are of great benefit to patients who 
have been bedridden. Since these exercises stimulate the circulation of the 



















Gymnastics 


THE STANDARD FAMILY PHYSICIAN 


386 



Fig. 181. Standing on the toes. Fig. 182. Incomplete bending of the knees. 



Fig. 183. Complete bending 
of the knees. 


Fig. 184. Lunging laterally to the left, swinging the 
arms obliquely upward. 






























387 


THE STANDARD FAMILY PHYSICIAN Gymnastics 

blood in the vessels of the abdominal cavity as well as the movements of the 

bowels, their practise is advisable particularly in cases of hemorrhoids and 
constipation. 

(1) Raising the legs sidewise.—The upper part of the body inclines 
slightly to the right while the left leg is extended for a few moments (Fig. 
1 73 ) > the raised leg is then brought back into the standing position, where¬ 
upon the same movements are repeated to the opposite side. Three to ten 
times. 

(2) Raising the legs forward. (Fig. 174).—To be repeated three to 
twenty times. 

(3) The same backward (Fig. 175).—Three to twelve times. 



Fig. 185. Lunging laterally to the right, swinging the arms 

obliquely upward. 


(4) Rotary movements of the thigh.—These are made by combining the 
three previous exercises. Movement 3 is executed first, and from the posi¬ 
tion shown in Fig. 175 the foot is made to describe a circle in the air (Fig. 
176). Three to six times. 

(5) Rolling movement of the leg.—The leg is raised either laterally, 
forward, or backward, and is rotated solely around its longitudinal axis, 
so that the leg scarcely changes its position, and merely the tip of the foot is 
rotated, first inward, then outward. Three to six times. Exercises 4 and 
5 pump the blood into the abdomen with great force. 

(6) Raising the knee (Fig. 177).—With the body erect, the left leg is 
raised and the upper part of the body inclined slightly to the right side, so 
that the entire weight of the body rests upon the right leg. Then the left 






















Gymnastics 


THE STANDARD FAMILY PHYSICIAN 


388 


leg is again extended in the direction of the arrow, and the same exercise is 
performed with the right leg. When both exercises are alternated rapidly 
and continuously, the movements executed resemble a walking on the spot 
with raising of the knees, an excellent exercise for cold feet. Three to 
twenty-five times. 

(7) Stretching of the leg.—From the position shown in Fig. 177, the 
leg may be extended in the direction of the arrow (Fig. 178). This exercise 
is suitable only for stronger persons. Three to ten times. 

(8) Raising the lower leg (Fig. 179).—The thigh remains in its usual 
position. 

(9) Bending and extending the foot (Fig. 180).—Exercises 8 and 9 are 
very suitable for patients with cold feet. 

(10) Standing on the toes.—With the body erect, and both hands rest¬ 
ing upon the hips, the heels are closely brought together, the tips of the feet 
directed outward; both heels are thereupon raised from the floor so that 
they are still in contact while the weight of the body rests on the toes (Fig. 
181). This attitude is kept up for several seconds, after which the heels are 
again lowered. Three to thirty times. 

(n) Jumping into the straddle position.—This exercise begins with the 
toe position (Fig. 181). In this attitude the feet remain for but a moment, 
and are then moved by a rapid jump simultaneously to the left and right; 
the first position is designated by footmarks in Fig. 168 and the arrows 
show the directions in which the feet are moved. While holding the feet 
apart the patient should draw several long breaths and then, by a similar 
jump in the opposite direction, bring his legs together again. Repeat from 
two to twelve times. 

(12) Incomplete bending of the knees (Fig. 182).—The heels remain 
closely together and are slightly raised from the floor, the knees a trifle 
bent. After a brief stay in this attitude the legs are again extended into 
the original position. Two to twelve times. 

(13) Complete bending of the knees (Fig. 183).—In this exercise the 
knees are bent lower than in No. 12; otherwise the exercise is the same. 
Exercises 12 and 13 are very suitable for men and boys, but not for girls and 
women. 

Combination Movements. —The following are a few examples of exer¬ 
cises which combine several movements. 

(1) Assume a position with the left knee bent as in Fig. 184, and 
alternate it with the attitude in Fig. 185 by swinging the arms downward 
and toward the other side, at the same time bending the right knee and 
stretching the left. 

(2) This is a combination of exercise No. 5 of Movements jor the Shoulder- 
girdle and Arms , and alternate raising of the knees (see Fig. 177), so that a 
movement of the arm is made simultaneously with a step on the spot. 




389 


THE STANDARD FAMILY PHYSICIAN 


Gymnastics 


Gymnastic Apparatus for the House.— A great number of practical 
apparatus for the house have been recommended. One of the oldest, and 
a very suitable one, is that of Largiadere, which is used to support the 
body in the exercise illustrated in Fig. 186. Interchangeable swinging 
rings and trapezes are likewise recommcndable for home exercises. 

An exercise as that shown in Fig. 187, performed with or without swing¬ 
ing, is suitable for strengthening the muscles of the back and of the chest. 
Fig. 188, an example of the many exercises possible with the swinging 
rings, shows how to execute an exercise that is eminently beneficial for 
the pelvis. The upper part of the body is made to rotate in such a manner 



Fig. 186. Bending the trunk sideways, one arm Fig. 187. Hanging in trapeze, with 

extended upward, the other downward. arms bent. 

as to describe the form of a cone, the point of which is represented by the 
tips of the toes. 

This exercise is highly advisable in cases of constipation, hemorrhoids, 
and slight curvatures of the spinal column. The movements should be 
made to the right and to the left alternately, and should be repeated from two 
to fifteen times in either direction. 

II. Orthopedic Gymnastics. —This form of gymnastics is employed 
when bones and joints have lost their normal position and movability 
owing to morbid changes. In addition to baths, massage, and electricity, 
they are essential in orthopedic practise. Only the most prominent meth¬ 
ods of application are here considered. Orthopedic institutes are resorted 
to mostly on account of curvatures of the spinal column. Since this 
disorder far more frequently affects girls than boys, it is evident that 














Gymnastics 


THE STANDARD FAMILY PHYSICIAN 


390 


muscular weakness is one of the chief causes. The object is, therefore, to 
strengthen principally the muscles of the small of the back and of the lat¬ 
eral portion of the back. Exercises for the relief of curvatures of the spine 
require great patience, on the part of the physician as well as of the patient. 
The examples in illustrations 151, 153, 154, 156, 157, 181, 193, and 195, 
serve to show the chief movements. In addition to spinal curvature, 
orthopedic gymnastics are important for the correction of faulty positions 
of the feet. In many of these patients a preliminary operation may be 
necessary. 

In the after-treatment of injuries another extensive field is open to 

orthopedic gymnastics. The degree of success in the treatment of these 



Fig. 188. Rotary swinging, to right and left alternately. 

after-effects is quite considerable. It is very arduous work. It is necessary, 
in the first place, that the physician knows exactly the capacity and extent 
of motion of every joint. Then he proceeds very gradually, and step by 
step. The treatment should begin carefully with passive movements; that 
is, with those which the physician performs without the aid of the patient. 
Many of the exercises spoken of under the head of curative gymnastics are 
of value. Some of special importance are here considered. 

Figure 189.—The patient stands erect, with the feet apart, holding 
the upper arms horizontally, and the forearms bent at right angles. The 
physician, standing behind him, so places his arms under those of the 
patient that the latter rest comfortably upon the arms of the physician. 
Then, during inspiration, the arms and the entire shoulder are raised, 
being again lowered during an expiration, the physician at the same 

time causing the patient’s upper arms and shoulders to describe a small 
circle. 















391 


THE STANDARD FAMILY PHYSICIAN 


Gymnastics 


Figuie 190. The patient is seated upon a chair with his knees together, 
his hands resting upon the hips. The physician, seated in front of the 
patient, places his hands upon the latter’s shoulders and turns the upper 
part of his body alternately toward the right and toward the left, in all 
three or four times to each side. If the patient supports the movements 
of the physician, the exercises are no longer called passive, but assisting 
exercises. 

Patients afflicted with less severe affections must perform active move¬ 
ments, without the assistance of the physician. Exercises of this character 
are found under Curative Gymnastics. The physician terminates the 




Fig. 189. Raising and lowering Fig. 190. Turning the trunk sideways, 

the shoulders. 

treatment by orthopedic gymnastics with movements of resistance; that 
is, he offers resistance to the active movements of the patient. Four exam¬ 
ples of these movements, of which there are a great many, will be found 
in Figs. 199-202, under Swedish Gymnastics. 

III. Respiratory Gymnastics.—These are to be distinguished from 
other gymnastic methods by the fact that they do not require the assistance 
of other persons or the use of any apparatus. For this reason they have 
always found great favor with the public. The fanatics who give them¬ 
selves up to the extremes of cold-water treatment are well matched by a 
similar class who are followers of this method of gymnastics. These per¬ 
sons usually possess some one of the well-known works on ‘‘home gym¬ 
nastics” and apply its teachings for every purpose. The general rules 














Gymnastics 


THE STANDARD FAMILY PHYSICIAN 


392 


contained in such books are suitable perhaps for healthy individuals, but 
people who are ill can be benefited only by regulations adapted to each 
particular case. This choice of exercises is rendered possible by the highly 
developed character of the system of respiratory gymnastics. 

The various procedures, which are more or less complicated, require 
care and judgment in their execution; and the most practical form of giving 
the necessary instruction is by means of a series of sessions in which the 
details may be carefully explained. The instruction must include, not 
only the demonstration of the individual exercises, but also the effects 
of the respiratory movements; for it is of extreme importance that the 
patient should acquire a knowledge of the principles of the treatment, 
even if that knowledge be somewhat superficial. Without such knowl¬ 
edge the patient will not be able to carry out the treatment intelligently, 
because mere mechanical and thoughtless movements fail to accomplish 
the desired results. 

An endeavor will therefore be made to present the main points of such 
a course of instruction, although the force of example and the personal 
supervision of a trained instructor are two essentials which can not be sup¬ 
plied. Three main divisions of the subject are to be noted: (i) bilateral 
and unilateral respiration; (2) the various forms of respiration; and (3) 
the respiratory periods. 

In bilateral respiration distinction must be made between thoracic and 
abdominal breathing, as discussed on pages 52-53. The muscles which 
necessarily act are the costal muscles, the diaphragm, and the abdominal 
muscles. The respiratory act may, however, be made to include all the 
other parts of the body, with the exception of the forearms and hands, and 
the legs and feet. It is important to make use of the movements of the 
spinal column, for extension of the thoracic portion of the column increases 
inspiration, while forward flexion of the lumbar portion causes a diminution 
in size of the abdominal cavity and a corresponding increase in expiration. 
Backward movements, causing the lumbar vertebrae to form a straight 
angle with the sacrum, again favors inspiration. 

In addition to these, a number of movements are employed which 
involve the arms and shoulders. In the first place the entire shoulder- 
girdle, that is, the shoulders and the upper portion of the chest, may be 
raised and lowered. By elevating the shoulder-girdle, including the upper 
ribs, inspiration may be increased. In the second place, the shoulders 
may be moved forward and backward, without any effect on the respira¬ 
tion, but with the result of pulling on the apexes of the lungs. The back¬ 
ward movement of the shoulders, however, elevates the upper ribs and 
in this manner aids inspiration. The arms may assist this movement 
of the shoulders, if the hands are rested on the hips and the elbows then 
drawn backward, as shown in Figs. 191 and 192. In the third place, the 






393 


THE STANDARD FAMILY PHYSICIAN 


Gymnastics 


shoulders may be raised and lowered without using the upper portion of 
the chest, which results in aeration of the apexes of the lungs and a local¬ 
ized inspiration. As a lule this may be accomplished by carrying the 
extended arms from the sides above the head, as shown in Fig.°i93, 
holding them in this position until three deep breaths have been taken 
through the nose with mouth closed, and then returning them to their 
original position. Children may repeat this exercise about three times, 
adults up to eight times. If the hands are folded across the back and 
then suddenly thrust downward, as shown in Figs. 194 and 19s? an ex- 



Figs. 191, 192. Resting the hands on the hips, and drawing the elbows backward, 

to assist inspiration. 


piratory movement results, because the shoulders are lowered. This move¬ 
ment may be repeated five to ten times, inspiration taking place on folding 
the hands across the back, and expiration accompanying the downward 
movement. 

The next shoulder exercise is a combination of elevation and depression 
with forward and backward movements of the shoulders. This results 
in a rotation, which may be carried out in one or in both shoulders. The 
shoulder should be elevated and drawn forward in connection with inspira¬ 
tion; while expiration should accompany the depression and drawing 
backward. This exercise may be done with arms lowered in their natural 
position, by elevating the shoulders while drawing them forward, and 
lowering them while drawing them backwards. Or the movements may 
be increased by calling the arms into play. For this purpose the arms 
are carried above the head as shown in Fig. 193, and then downward and 














Gymnastics 


THE STANDARD FAMILY PHYSICIAN 


304 


forward (see Fig. 196) to the sides. This is done during expiration and 
constitutes the first half of the exercise. The second half consists in carry¬ 
ing the arms back as far as possible, and then upward until, after rotating 
the forearm, they are brought to their original position (see Fig. 193). The 
latter half of the exercise is done during inspiration. 

Another effectual exercise consists in extending the arms at right angles 
to the body, and then describing circles with the hands, as shown in Fig. 
197. This is a very practical movement, is attended by little fatigue, and 
may be repeated from five to fifteen times. 

In all the exercises just mentioned, a horizontal plane may be con- 




Fig. 193. Extending the arms above Fig. 194. Holding the hands folded 

the head. on the back. 

sidered as dividing thoracic from abdominal respiration, whereas a vertical 
plane separates right-sided from left-sided breathing. 

The movements of unilateral breathing shall be but briefly mentioned, 
because of themselves they have very little influence on respiration in gen¬ 
eral, one side of the chest being compressed while the other is being ex¬ 
panded. If the right side is to be favored, it may be done, as shown in 
Fig. 198, by holding the left side of the thorax at rest by pressure with the 
hand while breathing is carried on with the other half. The reverse of 
this is done when the left side is to be developed. 

In the next place, attention must be directed to the manner of breathing, 
as this has been very much neglected by the laity. A few essential points 
will be noted. Regarding the length of the respiratory act (that is, the num- 





















Fig. 195- Lowering the folded Fig. 196 . Lowering the arms with a 

hands on the back. forward movement. 

the various modes of breathing as found in daily life. Thus, coughing 
consists of a short projectile expiration through the mouth, following a 
prolonged inspiration; sneezing, of a short forcible expiration through 
the nose, preceded by a prolonged inspiration; sobbing, of rapid inspira¬ 
tions with contraction of the vocal cords, etc. The acts of laughing and 
crying are marked by spasmodic breathing. Laughing consists of short, 
, rapid expirations, while retaining the attitude of inspiration; and crying, 
of long and less frequent expiratory movements, while in the attitude of 
expiration. 

In addition to these procedures, resistance to the respiratory move¬ 
ments may be interposed as part of the gymnastic exercises. Even breath¬ 
ing through the nose, as compared with breathing through the mouth, 
introduces an element of resistance which benefits the body, for the intra- 
thoracic pressure is reduced by inspiration and increased by expiration. 


395 


IIIL STANDARD FAMILY PHYSICIAN Gymnastics 


bcr of breaths taken in any given period of time) two features are of inter¬ 
est. Slow, deep inspirations particularly favor the exchange of gases, the 
absorption of oxygen, and the excretion of carbonic acid; whereas rapid, 

superficial breathing serves rather to cool the respired air and to aid the 
excretion of moisture. 

The length and depth of the individual respirations is also of extreme 
importance. These may be regulated so as to yield a number of useful 
exercises, such as a slow inspiration with rapid expiration, or a quick, 
deep inspiiation followed by a drawn out and extended expiration. These 
distinctions aie not founded on imaginary differences, but are drawn from 

























Gymnastics 


THE STANDARD FAMILY PHYSICIAN 


396 


This quickens the pulmonary circulation, and stimulates the heait-action 
and the vessels of the entire circulatory system. If increased resistance 
is desired, the respiration may be carried on through the right and left 
nostril alternately, that which is not immediately employed being closed 
by pressure with a finger. When both nostrils are held shut and the mouth 
is tightly closed, the ingress and egress of air is stopped, but the respiratory 
movements may be carried on by the usual muscular action. The exchange 
of air may also be inhibited to a considerable extent, even with the mouth 
and nose open, by laryngeal contractions. T his may be done by carrying 



Fig. 197. Describing circles with the hands. 


Fig. 198. Favoring the right 
lung in breathing. 



out the respiratory movements and then attempting to retain the air in 
the lungs by voluntarily closing the cleft between the vocal cords. In 
order to accomplish this, a deep inspiration is made, the larynx closed by 
the motion of swallowing, and then an expiratory movement attempted by 
means of the thoracic and abdominal muscles. Then again the opposite 
may be done, the larynx being closed after a strong expiration, after which 
the abdominal and thoracic muscles are relaxed. By this means marked 
differences in pressure may be elicited in the abdominal cavity. The 
abdominal organs are thus pressed together or separated, and in either 
case the heart is caused momentarily to cease its action. In this way the 
various body-cavities may be alternately filled with blood or deprived of 
the same. 

This variety of breathing-exercises should not be practised more than 
from three to five times. If it is desired to do it any oftener, an intermis¬ 
sion of at least ten minutes should be allowed for rest, or, if this is not 

































397 


1HE STANDARD FAMILY PHYSICIAN Gymnastics 


needed, other gymnastics may meanwhile be practised. So long as one 
feels well while carrying on this form of respiratory gymnastics, no harm 
will result; but great care should be taken not to overdo the exercising. 
Owing to the fact that the heart-beat may be suspended during the act, 
ovciindulgence may bring on a faint, or, in exceptional circumstances, 
death. Such severe cases are usually heralded by some premonitory warn¬ 
ing signs. When these appear the exercise should be stopped; and when 
repeated at a future time it should not be carried to excess. 

Repression of all the movements of breathing results in a respiratory 
pause. A long breath may be taken with the mouth tightly closed, and 
the air retained as long as possible. W'hen this limit has been reached, 
the breath may be quickly released. According to Professor Niemeyer 


Fig. 200. Attempting to bend the arm under 
resistance. 

these pauses afford a ready means of testing a healthy lung; for a man 
with well-developed thoracic organs can retain this position for about a 
minute. 

The exercises just described should be limited in their application to 
those who are perfectly healthy, or to convalescents who are not afflicted 
with organic disability, for the purposes of strengthening and developing 
the lungs. Systematic, prolonged and deep respiration is to be recom¬ 
mended for those suffering from pulmonary troubles, and for those in 
whom a change in the contour of the thoracic cavity has been brought 
about by rickets. Deep and prolonged inspiration increases the flow of 
blood to the lung, aids its nutrition, assists bronchial excretion, strengthens 
the respiratory muscles, and renders possible the more complete filling of 
the right side of the heart with blood. Prolonged expiration while the 
vocal cords are contracted, as in screaming, singing, elocution, etc., di¬ 
minishes the flow of blood to the heart. With the next inspiration it again 
becomes overfilled. The favorable influence which deep breathing exerts 
on the body is well demonstrated in infants, who carry it out involuntarily 




Fig. 199. Attempting to stretch the arm 
under resistance. 




























Gymnastics 


THE STANDARD FAMILY PHYSICIAN 


398 


while screaming. It is a popular belief that crying infants always do well, 
and this belief is supported also by medical experience. If it is desired 
to practise deep and prolonged breathing as an exercise, the limits of normal 
inspiration and expiration should be determined with the second hand of 
a watch, and then the attempt made to prolong them. When it has become 
possible, without undue exertion, to prolong these periods so that an increase 
of several seconds is noted, efforts should be made to repeat these several 
times in succession; and when this can be done ten or twelve times with¬ 
out unusual effort, attempts should be made to prolong the individual 
respirations a second time, and so forth. It is advisable to alternate these 




Fig. 201. Attempting to bend the knee 
under resistance. 


Fig. 202. Attempting to stretch the knee 
under resistance. 


breathing exercises with other gymnastics; and singing, elocution, and read¬ 
ing aloud are also to be recommended. The various respiratory exercises 
may be carried out to a certain extent with one lung at a time. 

The term “breathing period” may be applied to a combination of the 
different respiratory exercises. For example, a period may consist of five 
deep inspirations, interpolated with four short, and a final prolonged and 
deep, expirations. By such combinations the effect of the various types 
of respiration may be increased, either by strengthening and prolonging 
the individual movements, or by alternating opposing exercises, such as 
voluntary expansion and contraction of the thorax. 

The direction of these exercises by the physician consumes both time 
and patience, but there is no doubt of their value and of the good results 
which may be accomplished. Among the great variety of respiratory exer¬ 
cises which have been devised, only a physician is able to select those which 
shall prove most suitable to the condition of the individual patient. It is 
ridiculous for patients to follow a promiscuous course of gymnastic exer¬ 
cises of this kind without any regard for the condition which it is desired 
to benefit. 














399 


THE STANDARD FAMILY PHYSICIAN 


Gymnastics 


Respiratory gymnastics are indicated in all diseases whose symptoms 
would be improved by increased muscular activity: a weak voice, narrow 
chest accompanied by general bodily weakness, tendency to pulmonary 
consumption, or bronchial catarrh. In all diseases characterized by 
mechanical disturbances which would not be benefited by muscular activ¬ 
ity, or which might even be aggravated thereby, the respiratory exercises 
should be omitted, or should be practised only in selected cases, and 
with the utmost precaution. Among such diseases may be mentioned 
contraction of air-passages, asthma, emphysema, pleurisy, and empyema. 
In these conditions treatment by special pneumatic apparatus may be 
indicated. 

In pulmonary consumption, where the course of the disease has been 
halted, respiratory exercises may be of great assistance, but especial precau¬ 
tions must be taken against hemorrhages and the extension of the tuberculous 
process. The exercises should be taken only on the recommendation and 
with the consent of the attending physician. In consumptives the attitude 
of inspiration should be encouraged, directions being given to draw the ribs 
upward and to push the backbone forward. These inspiratory exercises 
must not be overdone, as they are apt to cause vertigo, to bring on hem¬ 
orrhages from the nose and lungs, or to cause a rush of blood to the head. 
After an attack of pleurisy, unilateral exercises may be undertaken only 
when recovery is far advanced. Emphysematous cases will be benefited 
only by those exercises which favor expiration. 

Respiratory exercises are also indicated in many general diseases, inclu¬ 
ding anemia, chlorosis, obesity, diabetes, and neurasthenia. In persons who 
have recovered from severe illness they are likewise often advisable. 

IV. Swedish Gymnastics.—The chief characteristic of Swedish gym¬ 
nastics is that they require the assistance of a second person, resistance to 
the patient’s movements being the main feature of these practises. A few 
explanations may illustrate the effects of these resistance gymnastics. 

Every contraction of a muscle causes the sensory nerves to be pressed 
upon by the muscle-fibers. This stimulation is transmitted directly to 
the brain and spinal cord, from where the stimulus is in turn imparted 
to the different parts of the body which stand in connection with the stimu¬ 
lated nerve-centers. As a result these parts of the body are better sup¬ 
plied with blood; and therefore better nourished. By offering resistance 
to the patient’s movements, as is done in Swedish gymnastics, the pressure 
exerted upon the sensory nerves by the muscle-fibers becomes stionger, and 
as a result the beneficial stimulation becomes greater. These gymnastics 
exert a favorable influence also upon respiration and upon the heait, and 
are therefore frequently employed in cardiac conditions. 

The accompanying four illustrations may serve as examples of the 
various resistance exercises. Fig. 199 shows a patient attempting to stretch 




Gymnastics THE STANDARD FAMILY PHYSICIAN 


his arm under resistance from the second person, who cxeits an opposing 
force in the direction of the arrow. Fig. 200 represents the opposite case, 
the patient endeavoring to bend his arm while the assistant draws it toward 
himself. Figs. 201 and 202 illustrate similar exercises for the legs, the 





arrows showing the directions in which the assistant exerts his resistance 
to the patient’s movements. 

Swedish gymnastics are employed with beneficial results in certain 
female diseases, in which it is of importance to influence the circulation of 
the blood in the abdomen. Measurements have demonstrated the fact 
that these exercises cause a diminution of temperature in the female genital 
organs. Whether it is possible also to bring about an increase of tempera¬ 
ture, is at least questionable; at all events, investigations along these lines 
have not as yet furnished any positive support for this assumption. The 
Swedish investigator Thure Brandt (d. 1896), who concerned himself most 
exhaustively with the mechanical treatment of female diseases, discovered 
through experiments the different exercises which influence the circulation 



























401 


THE STANDARD FAMILY PHYSICIAN 


Gymnastics 

Hair 


of the blood in the pelvis. A scientific criticism of his theories was not 
furnished by physicians until later. This criticism has proved that by 
no means all of the contentions are tenable which Brandt advanced in his 
enthusiasm for his method. 

Swedish gymnastics were elaborated and systematized by Per Henrik 
Ling (1776-1839) of Stockholm. After a brief period of full development 
they fell into oblivion, owing partly to the boasting of many adherents of 
the system, and partly to their indiscriminate application by Swedish pro¬ 
fessors of gymnastics. They did not come into favor again until the Swe¬ 
dish physician Zander substituted mechanical devices for human forces. 
Every movement of the body may now be executed by a separate apparatus, 
so that a collection of 40 to 80 machines are required. Institutes in which 
such machines are used are called Medico-Mechanic Institutions. Figs. 
203 and 204 are examples of the machines invented by Zander. 

GYNOCARDIA.—This is obtained from Gynocardia odorata , and per¬ 
haps from other related species, large trees, native to Burma. The seeds 
contain a high percentage of oil, which is extracted by various methods. 
Chaulmoogra oil, as it is called, is extensively used in veterinary practise, 
and has come to be wfidely applied as a remedy in the treatment of leprosy 
and chronic skin conditions. 


H 

HAIR, CARE OF.—Although heredity plays an important part in the 
development of the hair, much may be accomplished toward directing its 
growth in a favorable manner. Up to about its sixth year, the child’s 
hair should be frequently cut in order to insure a vigorous growth. It 
should be borne in mind that long, thick, curly hair is a great accumula¬ 
tor of dust, and that hair which is kept moderately short can be most readily 
washed and cared for. Boys should under all circumstances wear their 
hair closely cropped. Hair which preserves its natural luster without 
being damp or greasy, does not require any other care than the fiequent 
washing with soap (about twice a week). Dry, bristly, lusteiless hair is 
best treated with lanolin or other pomades. It is highly advisable to take 
care of the hair also before going to bed; and it should be remembered that 
artificial measures to promote its growth can act much moie efficaciously 

during the night than in the dust of the day. 

Hair-brushes should be selected with moderately stiff biistles, so that 
they may give the scalp a certain amount of massage. Bioad, double 
brushes (one for each hand) are to be recommended. Hair-brushes should 
be cleaned often and thoroughly, as otherwise an incredible amount of 
dirt will accumulate in them. It is advisable to free the brush of hairs 




Hair 


THE STANDARD FAMILY PHYSICIAN 


402 


and dust directly after using. The combs used should have dull teeth, in 

order that they may not injure the scalp. 

Dandruff is one of the most frequent disturbances of the growth of 
the hair. This affection, which is characterized by the formation of a 
scurf which comes off in fine scales, not only gives the hair a dusty gray, 
lusterless appearance, but also creates the impression of uncleanliness on 



the part of the individual thus affected, on account of the condition of the 

clothes. At the onset it should 
be stated that the application 
of alcoholic hair-tonics (and 
most of the widely advertised 
remedies of this kind contain 
larger or smaller amounts of 
alcohol) is absolutely out of 
place. Such remedies are ex¬ 
tremely harmful, since they 
only tend to dry the scalp in 
consequence of the evapora¬ 
tion of the alcohol. 

According to medical ex¬ 
perience there is only one 
remedy which is efficacious 
in this condition, and that is 
shampooing the scalp with 
the yolk of an egg. This 
remedy is prepared by stir¬ 
ring the yolk of an egg with ten 
drops of chloroform until it 

Fig. 205. Circumscribed areas of gray hair. 

forms a bright yellow mass re¬ 
sembling ointment. This should be firmly rubbed into the scalp and around 
the roots of the hair, about a teaspoonful being used at a time. This process 
should be repeated twice a week, and after each application the excess of 
yolk should be washed out with a good lanolin soap and the hair rubbed 
dry with a linen towel. 

Prematurely gray hair is another condition which is of rather frequent 
occurrence. The color of the hair is due (1) to a certain pigment furnished 
by the hair-follicle and derived from the coloring matter of the blood, 
which latter also causes the racial color of the skin; and (2) to the light- 
refraction from the hair. It follows, therefore, that changes in the color 
of the hair may be caused either by the absence of pigment (as in circum¬ 
scribed areas of gray hair; see Fig. 205), or by the entrance of air. In 
the latter case the air-bubbles diminish the transparency of the hair and 


reflect the light which strikes it, just as dull (uneven) glass appears to be 







403 


THE STANDARD FAMILY PHYSICIAN 


Hair 


of a milky white color because the white light is refracted in many rays. 
That the hair becomes gray with age is mostly due to the entrance of air 




into the marginal cells of the 


hair-shafts which have become 
more brittle; much less fre¬ 
quently to the absence of pig¬ 
ment. The fact that the hair 
may turn gray all of a sudden in 
consequence of sorrow, fright, 
excitement, pain, etc., can be 
explained only as being due to 
a sudden change in the amount 
of fluid contained in the hair- 
shafts, and which paves the way 
for the entrance of air into the 
outer layer of the scalp. 

A marked loss of hair takes 
place after infectious diseases, 
such as typhoid fever, influenza, 
diphtheria, syphilis, etc. This 


represents a troublesome form 

.biG. 206. Complete baldness. 

of affection, a true weakening 

of the scalp; and the deficiency of hair-formation leads to complete bald¬ 
ness (see Fig. 206). It is beyond question that predisposition (heredity) 
as well as acquired injuries are factors in causing this affection which, 
probably on account of an erroneous belief in the possibility of losing 

the hair in consequence of 
excessive enjoyment, often 
causes the afflicted individual 
to become the target for sar¬ 
casm and raillery. However, 
the mode of living has but a 
very limited influence upon 
the loss of hair, and only in 
so far as it is fraught with 
special dangers. Youthful 
dissipations and early bald¬ 
ness have very little relation 
to one another. The loss of 
hairoften occurs in almost reg¬ 
ular, circular or oval spots (see 
Fig. 207). The cause of this phenomenon is not fully explained as yet; either 
nervous influences or the action of fungi are held responsible. Treatment 


Fig. 207. Bald spots. 



















Hair-Dyes 

Hardening 


THE STANDARD FAMILY PHYSICIAN 


404 


consists in the application of stimulating or disinfecting remedies, such as 
tar in the form of soap, or mixed with the yolk of an egg. If mental exer¬ 
tions are held responsible for the loss of hair, other symptoms affecting the 
general health should be sought for. Pressure of the hat-rim is like¬ 
wise often wrongfully regarded as the cause of circumscribed baldness. 
It is possible that continued pressure may diminish the blood supply to 
the scalp, and thus cut off the nourishment of the hair-follicles. In such 
a case it is advisable to invigorate them by frequent massage (combing) 
and by washing with the yolks of eggs. The various remedies, so exten¬ 
sively advertised, are not likely to accomplish more than massage combined 
with the application of tar and egg-yolks. 

HAIR-DYES.—The modern art of dyeing the hair has advanced so far 
that it is able to comply with the taste (or lack of it) of every one who is 
prompted by the singular desire to improve upon nature by changing the 
color of his hair. Caution should be given against such a step into the 
dark unknown. The majority of those who have had their hair dyed, 
have been thoroughly dissatisfied with the result. Since the proper dyeing 
of the hair requires a thorough knowledge of the properties of the dye 
employed, the experiment should never be undertaken without the aid of 
an experienced hair-dresser. Harmless hair-dyes do not exist. 

To prevent the hair from turning gray, frequent washing with the yolk 
of eggs can be recommended. The oil of eggs is an old Roman device for 
preserving the hair. Neat’s-foot oil has also been highly and justly recom¬ 
mended as a means of darkening the hair. 

Hair-dyes in pomades act very slowly, and must be used daily until 
the desired results have been attained. Those prepared from vegetable 
ingredients are in general to be preferred to those containing metallic sub¬ 
stances. Walnut shells and green walnuts dye blond or gray hair, first 
yellowish, then dark brown; but the color is not durable. Nut pomade 
is of no use whatever. The action of nut extract is due to jts contents of 
iron chlorid, pyrogallic acid, copper chlorid, and free hydrochloric acid. 
Powder made from the leaves of the henna-bush and the indigo-plant in 
correct mixtures (which may be determined by experimenting with bristles) 
will give shades of yellow, orange, brown, and deep black. Brown coal 
(lignite) with ammoniac, potash, and peat-water—a mixture knowr as 
“Nerin”—is also used for dark shades. Kohol is India ink with gum dis¬ 
solved in rose water; mixed with silver salts, verdigris, iron tannate, lead 
carbonate, and other mineral substances, it gives dark shades. 

Blond shades (in great favor among certain lower classes) are acquired 
by washing the hair with hydrogen peroxid. Dyes that contain lead (and 
these are by no means few) are particularly dangerous, often leading to 
lead-poisoning. Before applying the dye, the hair should be freed of all 
fatty matter by the application of a mixture of twenty parts of chloroform 





405 


THE STANDARD FAMILY PHYSICIAN 


Hair-Dyes 

Hardening: 


with eighty parts of alcohol. The dye is applied with a comb and a new 
tooth-brush, and the hands should be protected by gloves. 

HAMAMELIS (WICH-HAZEL).—The bark, twigs and leaves of Hama- 
melis Virgiana , a widely distributed shrub or small tree, indigenous to 
the eastern and central parts of North America. The active principles 
found in hamamelis are tannic acid and volatile oils. Its chief value lies 
in its contents of tannic acid; and it is therefore useful as an astringent 
gargle in mild sore throats, and may be of certain service also as a local 
application in hemorrhoids. Taken internally it has the action of other 
mild astringents. Wich-hazel is largely used as an external application 
for sprains, bruises, wounds, etc. In these conditions, however, it has 
no specific action, its chief value resulting from the fact that it is cleansing, 
and that the alcohol used in the preparation of the remedy is antiseptic 
and cooling. A weak solution of alcohol is just as beneficial as a wich-hazel 
solution, and is much cheaper. 

HANDS, PERSPIRATION OF. —See Skin, Care of. 

HARDENING.—A great deal of harm has been done by the indiscrim¬ 
inate use of measures for which this term has furnished an excuse. Many 
a sick person has been permanently injured by senseless procedures with 
which it was intended to harden the system. Great care must always be 
exercised in employing such remedies. 

The term “hardened” may be applied to the body when it has become 
inured to changes in temperature to such a degree, that every change in 
temperature does not necessarily bring on a cold. This depends on the 
ability of the blood-vessels in the skin readily to adapt themselves to differ¬ 
ences in temperature of the air or the water. The rapidity with which 
the reaction in the skin takes place is the important factor. The blood¬ 
vessels must dilate or contract very quickly, and thus become rapidly filled 
with or emptied of blood. 

Two forms of hardening must be considered: that of the outer skin, 
and that of the mucous membranes lining the respiratory organs. When 
the former becomes inured, the latter usually take part in the process. 
This, however, is not always the case, for the mucous membranes may be 
locally inflamed owing to confinement in stuffy rooms, dusty or smoky 
air, or to congestion brought about by excessive speaking, singing, or indul¬ 
gence in alcoholic beverages. In such cases measures which tend to harden 
onlv the outer skin will be found insufficient, and the local causes must 
be removed. The patient should forego the use of alcohol and tobacco, 
avoid singing and speaking, and take care to inhale pure, warmed air, if 
necessary by a change of residence. In this way the catarrhal condition 
brought about by irritation will be removed, and thus the mucous ^mem¬ 
branes will become strengthened and hardened, and will be bettei able to 

withstand sudden influences. 





Harelip 

Hay-Fever 


THE STANDARD FAMILY PHYSICIAN 


406 


The outer skin may be hardened by increasing its power to react during 
changes of temperature. For this purpose a good circulation must be 
provided for, and the blood itself must be in good condition. This may 
be accomplished by appropriate nourishment, gymnastic exercises, the ad¬ 
ministration of suitable medicines, by keeping out in the open air and in 
the sun, by wearing proper clothing, by sleeping with a window open when 
the weather is favorable, by avoiding drafts, and by taking daily sponge 
baths of the entire body, at first with lukewarm, later with cold water. 
Numerous difficulties may attend these measures when the person is or 
has been ill, and they must always be carried out gradually, and under 
careful supervision. Moreover, the body must first be sufficiently strength¬ 
ened in order that its powers of resistance may be increased. After acute 
diseases, convalescence should be far advanced before anything is done. 

Children may be hardened by giving them warm baths followed by cool 
douches, but not by cold baths or cold douches alone. The wide-spread 
custom of immersing infants in a cold bath is dangerous, and numerous 
warnings have been circulated by eminent physicians as to the harmful 
character of this proceeding. A cold bath deprives the child of too much 
body-heat at once, and in many instances the custom has undoubtedly 
laid the foundation for subsequent nervous troubles and other diseases. 
Infants may be most readily inured by gradually lowering the temperature 
of the daily bath during the first year, say from 95 0 F. to 78° F. 

HARELIP AND CLEFT PALATE. —The formation of the face in the 
developing child is accomplished by outgrowths which proceed from the 



Figs. 208-210. Harelips. 


forehead and the upper jaw on both sides, joining in the center. The 
more or less incomplete union of these outgrowths, in consequence of dis¬ 
turbances of development, results in permanent fissures in the upper lip, 
in the upper jaw, or in the palate. These fissures may vary as to form 
and extension. A fissure of the upper lip forms the so-called harelip. 
This may consist either in a slight cleft at the border of the lip; or the 
fissure may extend through the entire lip up into the nostril (see Figs. 208, 
209, 210). As a rule the cleft is not formed in the center of the lip, but 
slightly to one side. A harelip may exist alone, or it may be combined with 
a cleft of the upper jaw and palate (cleft palate). Sometimes a cleft may 
form on each side, leaving an intermediate space between. 

Harelips not only disfigure the face, but are harmful to the health of 




407 


THE STANDARD FAMILY PHYSICIAN 


Harelip 

Hay-Fever 


the child. Nutrition usually suffers considerably, especially if also the 
palate is fissured so that the milk flows out through the nose. Intestinal 
catarrhs soon follow, and the deficient closure of the mouth often causes 
affections of the lungs. It is, therefore, not only desirable, but urgently 
necessary, to remove the harelip; and this should be attempted as early 
as possible. The treatment is operative, and in the mild cases usually 
easy to perform. The severe cases require great skill. The stronger and 
healthier the child, the more favorable are the prospects of a satisfactory 
cure; the poorer its nutritive condition, the less hopeful the treatment. 
Unfortunately the latter is often the case, as many parents will not agree 
to an operation until they see for themselves that the health of the child 
becomes more and more impaired. 

Conditions are different in cases of cleft palate. In these affections 
the fissure may be either single or double, a projecting centerpiece separa¬ 
ting the clefts if the latter condition exists. 

The operative union of the separated parts 
of the bones is a more serious matter than 
suture of the lips, and the treatment is not 
well borne by all little children. The sur¬ 
geon will be the proper judge as to the best 
time for performing the operation. 

HARVEST-TICK. —A small, six-legged 
insect, about J mm. long and broad, and 
of a red color (see Fig. 211). It habitates 
grasses and shrubs, especially gooseberries, 
and occasionally, late in summer, it makes 
its way into the skin of human beings, where 
its presence causes redness of the skin, 
nodules, pimples, and violent itching. In the center of each nodule and 
pimple the mite itself may be seen as a red spot. The parasite, which 
is otherwise harmless, is rapidly removed by embrocation with a scabies 
remedy, such as sulfur-ointment. 

HAWKING. —A symptom of various affections of the throat, occurring 



Fig. 2 i i. Harvest-tick. 


especially in catarrh of the Pharynx (which see). 

HAY-FEVER.—A catarrhal affection of the mucous membranes of the 
eyes and air-passages; called also summer catarrh, hay-asthma, etc. The 
true causes of hay-fever are still in doubt. It seems to be established that 
the affection occurs at the flowering-time of nature, and that it is caused m 
sensitive individuals by the pollen of various piants, eithci because ceitain 
ethereal oils, or other substances which develop under the influence of sun¬ 
light during the first flowering, have entered the air-passages together with 
the pollen, or because the latter have served as a means of conveying para¬ 
sites to the mucous membranes. It often happens that all persons who 



Hay-Fever 

Headache 


THE STANDARD FAMILY PHYSICIAN 


408 


live in the same locality, and who are sensitive to hay-fever, become affected 
about the same time. It is possible, therefore, to predict almost with cer¬ 
tainty when hay-fever will make its appearance in different places. It is 
not improbable that the psychic factor is a very large one in the develop¬ 
ment of hay-fever; and it is a noteworthy fact that the rural population 
is usually exempt from the disease. As a general rule, hay-fever affects 
only persons of the educated classes, so that it may be assumed that mental 
exertions and general nervousness create a diminished resistance to its 
causative factors. Societies which devote themselves to investigating the 
affection have been established at various times in various countries. 

The first manifestations of the disease usually appear immediately 
after the action of the injurious agent; as, for instance, after a walk across 
a meadow, or after smelling fragrant flowers. Occasionally the symptoms 
are preceded by general malaise, by loss of appetite, or by slight attacks 
of fever. Prominent symptoms soon manifest their presence by catarrh in 
the nose, in the conjunctivas of the eyes, in the pharynx, or in the ears; 
or there may be more or less severe attacks of asthma. 

Nasal catarrh develops with burning and itching sensations in the nose, 
increased secretion, tendency to sneeze, and obstruction to nasal respira¬ 
tion. By means of the naso-lacrimal canal the infection is conveyed to 
the conjunctivae of the eyes, where it gives rise to increased secretion of 
tears, fear of light, and swelling of the eyelids. This may be followed by 
catarrh of the pharynx, with sensations of itching, burning and dryness; 
and if the inflammation reaches the lower air-passages, cough and expec¬ 
toration may result. Violent pains occasionally occur in the forehead and in 
the back of the head; and slight fever is not infrequently a symptom. Hay- 
fever corresponds exactly to a well-developed asthmatic attack (see Asthma). 

An attack of hay-fever generally persists for several weeks, and may 
recur year after year if similar causes are active. Annoying as it is to the 
person affected, no severe disorders or even lasting illness develop as a 
consequence of the affection. There is no sure remedy for hay-fever, but 
the removal of the frequently existing swellings of the lower turbinate bones 
causes relief in many patients, and sometimes effects a permanent immu¬ 
nity to further attacks. Naturally, certain prevention is possible only through 
measures which entirely hinder the entrance of the injurious agents into 
the body. For persons of means it is especially advisable to travel to parts 
of the country which are free from hay-fever, when the time of flowering 
begins in their own locality. Among localities which are considered to be 
exempt from hay-fever may be mentioned high mountain regions, some of 
the islands of the North Sea (principally Helgoland), the Polar zones (where 
only mosses and lichens thrive), and the saltpeter coasts of northern Chile 
and southern Peru. The Baltic Sea offers no protection. In the United 
States the White Mountains, the Adirondacks, and the mountains of the 











.(auxslq IsoivTso) doaH brus bjsaH art} to asviaM Ijsrn9tx3 sriT— X 3TAJ3 
.sbnfilO (£) YiellixfimduS bne ( i ) bitoi£3 9riJ riJiw 







PLATE X —The External Nerves of the Head and 


Neck (cervical plexus), 


with the Parotid ( 1 ) and Submaxillary (2) Glands. 



Plate X 


















409 


THE STANDARD FAMILY PHYSICIAN 


Hay-Fever 

Headache 


west are favorite resorts. A curative serum has recently been prepared 
in Hamburg, but its efficacy is still to be proved. Frequent washing of 
the nose with antiseptic solutions often wards off an attack. 

HEADACHE. —A symptom of a great many disorders. They are so 
numerous that they can not all be mentioned in this place. Apart from 
accident, headache becomes manifest after mental and physical over¬ 
exertions, after overheating, exposure to cold, insomnia, difficult sleep, and 
emotions. It generally accompanies affections of the eyes, nose, stomach, 
intestine, kidneys, and sexual organs. Since headache is not an individual 
disease, but merely the symptom of a disease, it is important to determine 
the original affection. This is frequently a difficult undertaking, and 
physicians are often obliged to treat the headache as such, owing to its 
annoying nature. Among remedial measures may be mentioned cold or 
warm compresses, ice-bags to the head, hot or cold foot-baths, mustard 
poultices over the abdomen or neck, and electricity. 

These measures, however, will not always produce results which are as 
satisfactory as properly selected and correctly executed manipulations. In 
most cases of headache, notwith¬ 
standing the cause, there is an ex¬ 
cessive amount of blood, or a con¬ 
gestion of blood, in the cranial 
cavity. That this is the case may be 
inferred from the fact that redness of 
the face, plethoric veins, and throb¬ 
bing arteries frequently accompany 

5 ' ! 

this condition. The excess of blood 
may be mechanically removed by di¬ 
lating the outcarrying blood-vessels 
(the veins). This may be accom- 



& 


Fig. 212. 


..*#'» 

Nageli’s headache manipulations. 


plished by Nageli’s manipulations, 
which are carried out as follows; 

The patient is seated upright in the 
bed or upon a chair, with his back to the masseur. A watch with a 
second-hand is placed so that it is readily visible. The head of the 
patient is then grasped with the palm of the hand at the cheek-bone and 
the thumb at the back of the head, care being taken not to squeeze the 
lobe of the ear or to exert undue pressure with the thumb. The elbows 
of the operator are placed upon the shoulders of the patient or upon the 
back of the chair (see Fig. 212). Then the head of the patient is stretched 
upward, with a steady, strong, yet careful lift, until the neck has been 
extended about one and a half inches. The head of the patient is kept 
quietly in this position for about one or two minutes. If the patient com¬ 
plains of vertigo the manipulations are to be discontinued. 



Health-Care 
of Children 


THE STANDARD FAMILY PHYSICIAN 


410 


In very many cases of congestive headache, especially that due to fever, 
the pain disappears at once after this manipulation, and the head becomes 
free. The procedure may be repeated in five or ten minutes, when in 
numerous cases the headache will be removed permanently, or at least 
will disappear for hours. If it should recur, there is nothing to prevent 
another recourse to this painless and harmless procedure. It should not be 
employed, however, for patients who are suffering from grave diseases of the 
heart, or for very debilitated individuals. Neither should the manipulations 
be carried on recklessly, without a physician’s orders. 

If the headache is due to anemia of the brain, indicated by pallor of 
the face, a head-bending manipulation is often efficacious. The position 
of the hand and arms should be as in the preceding manipulation. The 
masseur should push the head of the patient in a horizontal direction, for¬ 
ward and downward. His forearms should be firmly supported against 
the shoulders of the patient, so as to execute a counter-pull. After 60 to 
90 seconds the head is slowly brought back into the regular position. By 
this procedure the veins of the throat are given a horizontal direction, or 
are even inclined downward, thus enabling the blood to flow more easily 
and rapidly through the blood-vessels. Hence, the head-bending manipu¬ 
lation causes a better flow of fresh blood through the brain. In order to 
continue its efficiency, this manipulation should be repeated after ten to 
fifteen minutes, for about one minute. 

Careful and detailed treatment is necessary in cases of obstinate nervous 
headaches which occur in persons who possess a nervous predisposition, 
and in individuals who have become nervous owing to mental or physical 
overexertions. Such obstinate conditions may be due also to excesses, 
unsuitable nourishment, or to injurious occupations. Headaches which 
can be directly traced to any specific bodily ailment likewise require special 
treatment. 

The first principle is to find the cause, and to remove it. Rational 
nourishment, abstinence from alcohol, and suitable clothing and occupation 
are the chief conditions of success. These are assisted by hydrotherapeutic, 
electric, or climatic influences. Many patients require special treatment of 
the eyes, nose, or ears, as an affection of any of these organs may be the 
cause of the headache. Constipation is one of the most frequent causes 
of this affection. In such a case the treatment should be dietetic rather 
than medicinal. See Constipation. 

HEALTH-CARE OF CHILDREN. —Under this heading shall be given 
only a few hints with regard to the proper care of children more than one 
year of age, a thorough discussion of the care of babies being found under 
Nursling. When children enter upon their second year of life a radical 
change may be made in regard to their nourishment. They may be gi-en 
eggs, soups, vegetables, fruits, and lean meat. Wine and beer should under 




411 


THE STANDARD FAMILY PHYSICIAN 


Health-Care 
of Children 


no circumstances be given to children under fourteen, and even then it is 
better that they abstain from these beverages. Coffee and tea, well diluted 
with water or milk, may be given to children after the fourth year of age. 
Pure fruit juices (lemon and raspberry), mixed with water, and sweetened 
with a little sugar, make wholesome beverages for young children. The 
daily fare of children between one and a half and two years of age should be 
made up about as follows: At 7 A.M., half a pint of milk; at 8.30, a soft- 
boiled egg or a raw egg stirred with a teaspoonful of sugar; at 11.30, a cup of 
soup or gruel, a slice of bread, and a small quantity of finely chopped vege¬ 
tables; at 4 p.m., half a pint of milk, either pure or with the addition of a 
teaspoonful of cocoa; and at 7 p.m., some milk porridge prepared with rice, 
tapioca, or some other cereal. No food should be given after 7 p.m. Care 
should be taken not to accustom the children to an abundance of sweets. 
When children are about three years old, they may be allowed to eat at the 
family table, but should not be given any spicy or very salt foods. 

In the course of the second year it is possible, by watchfulness and care, 
to train the children so that they announce when prompted by a call from 
nature. During the night, however, it often happens that even older chil¬ 
dren pass urine involuntarily. This condition is called “nocturnal enuresis,” 
and its causes and treatment are fully discussed under Enuresis. 

The daily body-bath, which is a necessity for very young babies who soil 
themselves, is not absolutely essential for children who keep clean. Spon¬ 
ging with soap and cool water once or twice a day serves not only to cleanse 
the child’s body, but also to harden it and increase its power of resistance 
against atmospheric changes (see Hardening). Healthy children over 
three years of age may advantageously be given daily sea- or river-baths 
during the summer months, and they should be taught to swim at an early 
age, possibly when six years old. On pleasant days children should be 
allowed to stay in the open air as long as possible, and should be given 
opportunity to play in dust-free places with other children of the same age. 
No task which imposes a mental strain should be required of a child less 
than seven years old. A young school-child should not be kept too close to 
studies, and should be spared as long as possible from doing work at home. 
Lessons in music should not be given to children of less than ten years of age, 

unless special talents manifest themselves. 

The requirements of sleep are greater in a child than in an adult. Nurs¬ 
lings are seldom awake for more than half an hour or an hour at a time, 
children between two and three years of age usually take a daily nap of 2 or 3 
hours, besides sleeping 10 or 12 hours at night. Children between the ages 
of six and ten require at least 10 hours’ sleep; children over twelve, 8 to 9 hours. 

The children’s room should be large, light, and airy, and easy to clean. 
The floor should be hard and smooth, and covered with matting, linoleum, 
or oilcloth. Walls painted with oil-paint are preferable to papered walls. 





Hearing- 

Heart 


THE STANDARD FAMILY PHYSICIAN 


412 


In winter an equable temperature should be maintained, and it is advisable 
to place a flat pan of water on the heating apparatus so as to keep the air 
sufficiently moist. 

The dress of children who are old enough to run about and play, should 
be made as loose and comfortable as possible. No restricting bands, no 

tight collars. The shoes should be waterproof and 
broad-soled, and large enough for comfort. The 
stockings should not be held up by means of 
elastic bands encircling the legs, as these tend to 
impede the circulation of blood. Hose-supporters 
fastened with clasps to the front part of the stock¬ 
ings and attached to the upper part of the child’s 
underwaist are advisable (see Fig. 213). To ac¬ 
custom little girls to wear corsets must be especially 
warned against, as the corset not only retards free 
respiration, but even displaces and compresses in¬ 
ternal organs (see Dress). By dressing children 
so that they can move and develop their muscles 
with perfect freedom, by encouraging them in 
wholesome plays and sports, and by endeavoring to 
cultivate at all times “clean minds in clean bodies,” 
three of the most essential requirements for the 
making of good men and women will have been ob¬ 
served. 

HEARING, DEFICIENCY OF.— More or less 
marked disturbances of the faculty of hearing may 
exist as a hereditary affection. This is particu¬ 
larly true in cases which are unaccompanied by suppurative or inflamma¬ 
tory processes. Deafness of one ear may remain undiscovered until each 
ear is tested separately. The normal ear is able to understand words 
softly spoken at a distance of sixty feet, but the circumstance that a whisper 
is not heard beyond a distance of eighteen feet does not necessarily indicate 
deficiency of hearing. It often happens that persons who are hard of hear¬ 
ing can perceive the sounds of talking without being able to understand 
what is said, as the syllables and tones sound confused. 

A perforation of the drum-membrane, not accompanied by the discharge 
of pus, does not necessarily affect the hearing to any great extent. Serious 
involvement of the membrane, however, will always cause defective hearing, 
because the sound-waves will then fall directly upon the auditory appa¬ 
ratus in the labyrinth, without being modified or regulated. In such cases 
an artificial drum-membrane, made of a wad of cotton, and introduced into 
the perforation, may afford relief to some patients. It subdues the sound¬ 
waves and prevents excessive tone impressions. 



Fig. 213. Sensible hose- 
supporters. 








413 


Hearing 

Heart 


THE STANDARD FAMILY PHYSICIAN 


Running of the ear always affects the acuity of hearing, and should 
never be treated lightly. Swelling of the tonsils, particularly of the pharyn¬ 
geal tonsil, distuibs normal breathing through the nose, and clogs the 
Eustachian tube, unless removed in time it will cause deficiency of hearing. 
In certain diseases defective hearing, or even deafness, may appear without 
any apparent suppuration; as, for instance, in abdominal typhoid, men¬ 
ingitis, whooping-cough, mumps, etc. Deafness may appear also after 
severe hemorrhages, and in consequence of injuries to the head, with or 
without fracture of the skull. Old age is usually attended by a certain 



Figs. 214—218. Various forms of ear-trumpets. 


degree of deficiency of hearing, the high notes being the first to become 
difficult of perception. 

Ear-trumpets seldom give satisfactory results. A trial may be made 
with the several varieties (see Figs. 214-218) to see which one will best 
answer the purpose for which it is intended. Screaming into an ear-trumpet 
affects the patient disagreeably; and when speaking into such an instru¬ 
ment one should talk neither too loudly nor too slowly, but distinctly and 
naturally. Prolonged conversation with persons who are hard of hearing 
is very trying and fatiguing for the voice. The frequent habit of lip-reading 
among the deaf is discussed in the article on Speech Disturbances. 

The various devices, apparatus, and methods, advertised in newspapers 
as being able to cure all cases of defective hearing, are to be most emphati¬ 
cally denounced. The money spent on these is invariably wasted, and it is 
always better to consult a physician than to invest in any of these so-called 
“unfailing remedies.” 

HEART. —For the structure and functions of this organ, see The 
Circulatory System in Introductory Chapters (pp. 60-61). 





















Heart 


THE STANDARD FAMILY PHYSICIAN 


414 


HEART, DISEASES OF.— As pointed out in the chapters on anatomy, 
the heart is to be considered as a two-sided, muscular pump. On one side 
it pumps blood into the lungs to be aerated the lesser circulation, on the 
other it pumps blood into the arteries to be carried to all parts of the body— 
the greater circulation. The movements of the two sides aie coordinated 
by the cardiac nerves. Hence disease may make itself manifest in at least 
three different parts of the organ. It may affect the muscular walls of the 
heart; it may involve the valves of the heart; or the nervous mechanism 
that causes the harmonious beating of the two sides of the heart may be 
interfered with. 

Affections of the muscular walls result as a rule either from excessive 
action of the heart (as is seen in athletes, soldiers who make forced marches, 
laborers who lift heavy weights, etc.) or from the injurious effects exerted 
by poisons upon the muscle tissue. Alcohol, tobacco, syphilis, etc., are 
among the most frequent causes; while the poisons of acute infectious 
diseases (pneumonia, typhoid fever, etc.) also exercise a marked effect upon 
the heart-muscle. Diseases of the valves may be due to defects in their 
mode of formation at birth; to the growths of micro-organisms (as in acute 
articular rheumatism, scarlet fever, pneumonia, typhoid, etc.); or to the 
deleterious influences of the syphilitic virus. The nervous defects are nu¬ 
merous. Distention of the stomach, indigestion, fear, worry, and over¬ 
work—all exert their influences upon the nervous mechanism. In some 
disorders (as Exophthalmic Goiter) excessive rapidity of the heart-beat 
may be noted; while in other diseases the opposite is observed. Only the 
more important heart-disorders can be here considered. 

Inflammation of the Heart-Muscle. —Acute inflammation of the heart- 
muscle may occur in the course of infectious diseases (such as articular 
rheumatism, typhoid fever, scarlatina, pneumonia, diphtheria, influenza, 
puerperal fever, and septicemia), in connection with inflammation of the 
pericardium, or, rarely, as a consequence of excessive physical exertion. 

Chronic inflammation of the heart-muscle, by which the musculature 
is transformed into callous and tendinous connective tissue, may either re¬ 
sult from the acute form, or may develop in consequence of poisoning by 
alcohol, lead, or tobacco, or as a result of syphilis, gout, diabetes mellitus, 
chronic inflammation of the kidneys, malaria, or inflammation of the peri¬ 
cardium. This disease includes also that form of degeneration of the 
heart-muscle which occurs in general arteriosclerosis in consequence of an 
affection of the coronary vessels of the heart. These vessels supply the 
heart with blood. But inasmuch as the heart can be nourished only during 
the intervals of rest, it follows that continuous demands upon this organ will 
lead to an impairment of nutrition. Such excessive demands are made upon 
the heart when it is called upon to overcome the great resistance offered to 
the circulation of the blood in consequence of calcification of the arteries. 





415 


THE STANDARD FAMILY PHYSICIAN 


Heart 


A similar overtaxation of the heart arises owing to the increased amount 
of water which is present in the blood in chronic inflammation of the kid¬ 
neys. The excessive use of cold baths, constant mental emotions, and severe 
physical overexertions (including excessive gymnastics) likewise increase the 
labor of the heart. Excessive physical exertions may also lead to a rapidly 
appearing dilatation and relaxation of the heart-muscle, with all the symp¬ 
toms of cardiac weakness; or they may cause a gradual enlargement of the 
heart with thickening of its walls. See Enlargement oj the Heart. 

Affections of the musculature of the heart manifest themselves princi¬ 
pally in certain changes of the pulse. Further signs of a weakened activity 
of the heart-muscle consist in shortness of breath, oppression of the chest, 
rush of blood to the head, ringing of the ears, vertigo, headache, insomnia, 
blue discoloration of the skin, and bronchial catarrh. If the heart itself has 
become appreciably weakened, the same manifestations occur as described 
under Dejects oj the Valves oj the Heart. 

Defects of the Valves of the Heart. —The thickening, calcification, or 
shrinking of the valves brings about a condition which prevents their clo¬ 
sing. This may give rise to an increased supply of blood to one or the other 
portion of the heart. Owing to adhesions and ring-shaped calcifications, 
a narrowing of the valvular openings may take place which prevents one 
or more portions of the heart from completely emptying their contents. 
Both of these conditions—imperfect closing, and permanent opening— 
modify the entire circulatory mechanism, and cause severe disturbances of 
the normal movement of the blood-stream. In its endeavor to compensate 
for these disturbances the heart performs an increased amount of work. 
This will either cause its muscular walls to become thicker (enlargement, 
or hypertrophy, of the heart); or it will give rise to enlargement of certain 
chambers of the heart, which may occasionally assume great dimensions, 
causing dilatation of the entire organ. 

The heart is often able to carry on this increased amount of work for 
decades without relaxing. But as soon as the increased muscular power 
of the heart becomes insufficient, very pronounced manifestations of cardiac 
weakness develop. These signs are characteristic also of many other af¬ 
fections of the heart. The speed of the blood-current decreases throughout 
the capillaries, and symptoms of congestion develop in all organs. This 
causes blood-serum to escape into the tissues, giving rise to the condition 
known as Dropsy. The skin covering those paits of the body which are 
remote from the heart becomes cool and dry, and of a bluish discoloration, 
the veins of the skin become more markedly dilated; and the lungs become 
congested because of an increased supply of blood, thus giving rise to diffi¬ 
culty in breathing. At times a painful cough develops, with profuse ex¬ 
pectoration of reddish, often bloody, sputum. Palpitation of the heart 
is an early symptom of weakness, and constant sensations of oppicssion 





Heart 


THE STANDARD FAMILY PHYSICIAN 


41G 


and fear prevail. The condition may cause disturbances also of the alimen¬ 
tary functions; and the urine usually becomes highly concentrated, and is 
voided in very small quantities. 

Valvular defects of the heart are brought about, especially during child¬ 
hood and adolescence, by a number of infectious diseases. In these affec¬ 
tions the bacteria circulating in the blood, or their poisonous secretions, may 
cause new growths or inflammatory changes in the valves. This is very 
frequently the case in articular rheumatism and in septicemia. Although 
of less frequent occurrence in diphtheria, scarlatina, pneumonia, chorea, 
typhoid fever, erysipelas, and gonorrhea, it should always be thought of as 
a possible complication in these diseases. A calcification of the main artery 
(the aorta) may, especially in advanced age, extend into, and cause defects 
of, the valves of the heart. Valvular defects are very rarely congenital; and 
they are seldom due to external injuries to the chest. 

In many cases of cardiac valvular defects the condition does not become 
manifest at the onset, especially when the existing disturbances are fully 
compensated for by the increased activity of the heart. It is possible, there¬ 
fore, that such a defect may remain unobserved for a long time. In ad¬ 
vanced cases the characteristic symptoms may arise during temporary or 
permanent attacks of cardiac weakness. It is possible to afford a con¬ 
siderable amount of comfort to patients suffering from such valvular dis¬ 
turbances, particularly when they are present in the milder degrees. Even 
very sick patients may be greatly benefited. See General Rules jor the 
Prevention and Treatment oj Heart-Diseases. 

Enlargement of the Heart.—This condition may result from a thickening 
of the walls of the heart, or from a widening of the heart-cavities (dilata¬ 
tion). These morbid conditions of the heart are usually associated with 
each other. They may affect either the entire heart or only a part of it; 
as, for instance, the right or the left chamber. The chief causes of enlarge¬ 
ment of the heart are valvular defects, and calcification of the arteries 
(<arteriosclerosis ). Inflammation of the kidneys, expansion of the lungs, 
constant bodily overexertion, high living, alcoholism, and permanent men¬ 
tal excitements are other potent causes. Dilatation of the heart may occur 
from the same causes, and may develop also as a result of inflammation of 
the heart-muscle ( myocarditis ), or in consequence of severe febrile affec¬ 
tions, as typhoid fever or pneumonia. Acute dilatation frequently occurs 
during the excess of athletic exercises. The principal disturbances expe¬ 
rienced by the patient are shortness of breath with attacks of dizziness and 
fainting. For principles of treatment, see General Rules jor the Prevention 
and Treatment of Pleart-Diseases. 

Fatty Degeneration of the Heart.—This affection is due to certain changes 
in the heart-muscle, induced by excessive fat, and giving rise to uniform 
symptoms. One form, the so-called “fatty heart” (usually a part symptom 










417 


THE STANDARD FAMILY PHYSICIAN 


Heart 


of general obesity), is brought about by the excessive deposit of fat below 
the heart in the pericardium, or by an infiltration of the fat between the 
muscle-bundles of the cardiac muscle. In the former case the heart is 
pressed upon by the pericardium; in the latter, its activity is impaired by a 
diminution of the firmness and strength of its muscle. 

Another form of this affection consists in a fatty degeneration of the 
heart-muscle itself. This may be due to a disturbance of nutrition which 
may develop as a further consequence of fatty heart; or it may be an in¬ 
dependent affection, at times arising from poisoning (as by arsenic, anti¬ 
mony, phosphorus, alcohol, or tobacco). In this form of the affection the 
fat is not deposited between the muscle-bundles, but the muscle substance 
itself is transformed into fat. The affection may arise also as a result of 
calcification of the coronary arteries of the heart, in severe diseases of the 
blood, or as a consequence of constant overexertion in the presence of an en¬ 
larged heart. Certain infectious diseases, as puerperal fever, typhoid, diph¬ 
theria, smallpox, malaria, and tuberculosis, may likewise give rise to fatty 
degeneration of the heart. 

The symptoms due to fatty degeneration of the heart are: palpitation, 
sensations of fear and oppression, shortness of breath, changes of the pulse, 
etc. These manifest themselves even when the body is fully at rest, but 
are intensified after the slightest bodily exertion, and upon mental work and 
excitement. Measures tending to overcome this affection are primarily 
directed toward combating the general obesity. Antifat cures, undertaken 
by the patient on his own responsibility, are apt to be exaggerated, and may 
often be followed by injurious consequences. Thus, if the fatty cushion 
of the heart is made to disappear rapidly, the heart loses a support, and re¬ 
laxation and dilatation of the organ are very liable to arise. The diet should 
be restricted principally to meat, vegetables, and fresh fruit; whereas starchy 
foods, sugar, and large quantities of fluid should be avoided. 

Palpitation of the Heart.—Even under normal conditions the activity of 
the heart is influenced by the individuality of its possessor. Age, dispo¬ 
sition, emotions, etc.—all exert their various influences upon this organ. 
It is not only the mental emotions or physical exertions, however, which 
manifest an action upon the heart; for, owing to the intimate correlation 
existing between this organ and all the other viscera of the body, most phys¬ 
ical and nervous affections are accompanied by deviations from the normal 
heart-beat. Palpitation of the heart becomes of importance when a dis¬ 
turbance of the rhythm occurs in addition to acceleration and intensification 
of the heart-beats, or when it sets in upon the slightest bodily exertion, un¬ 
accompanied by any other external cause. Besides being an early symp¬ 
tom in almost all diseases of the heart, palpitation is noted principally during 
fever, in anemia, and in many cases of poisoning. 

Very frequently the palpitation is a purely nervous symptom, being 




Heart 


THE STANDARD FAMILY PHYSICIAN 


418 


present regularly in anemic, excitable, or nervous individuals. It consists 
in a more or less marked increase in the rate of the heart-beat. This comes 
on in attacks, and is associated with vertigo, headache, sensations of fear 
and oppression, pains in the region of the heart, flushed face, and increased 
perspiration. Women are especially liable to such attacks during the 
periods of adolescence, menstruation, and the menopause. Palpitation often 
results from too good living. Overfilling of the stomach, accompanied with 
digestive disturbances, is the most important cause. Other causative fac¬ 
tors are: constipation; hemorrhoids; sexual excitement; excessive use of 
tea, coffee, alcoholic beverages, or tobacco; exophthalmic goiter; and con¬ 
valescence from severe, especially febrile, diseases. Thus it may be seen 
that cardiac palpitation may be the expression of a trifling disorder, or the 
result of grave disease. To determine the exact cause of palpitation requires 
the best medical skill obtainable. 

Spasm of the Heart (Angina Pectoris). —An affection which is character¬ 
ized by sudden acute pains in the region of the heart, occurring without any 
external cause. These pains are usually excruciating, and often radiate 
into the left shoulder and left arm, frequently causing sensations of cold 
or of numbness in these parts. The patient has a feeling as if the heart 
were held in an iron grip by an invisible hand, or were being torn to pieces. 
The pains may become so violent that they almost suggest a wish for the 
destruction of life. At the same time there are usually present a marked 
feeling of oppression, a sensation of fear, shortness of breath, changes of the 
pulse, pallor of the face, and cold perspiration; fainting spells and con¬ 
vulsions are not as frequent. The affection occurs as a result of calcifica¬ 
tion and dilatation of the arteries, in defects of the valves of the heart, and 
in affections of the heart-muscle; but it may be due also to gout, hysteria, 
and neurasthenia, or to the effects of severe colds, mental emotions, phy¬ 
sical overexertions, and the abuse of alcohol and tobacco. 

The disease occurs generally in persons of advanced age, although those 
afflicted with true angina pectoris rarely attain a higher age than 55 or 60 
years. Active medical treatment is imperative. The discussion of the 
prevention and treatment of this affection will be found in the following 
paragraphs on General Rules for the Prevention and Treatment oj Heart- 
Diseases. 

General Rules for the Prevention and Treatment of Heart-Diseases.— 

The prevention of affections of the heart can be accomplished only by con¬ 
stantly guarding against their causes. Against many of these, however, 
medical science is at times powerless. The most important causes of 
valvular disorders are the infectious diseases. Measles, scarlet fever, acute 
rheumatism, and diphtheria are frequently the precursors of heart-affec¬ 
tions. Hence it is imperative to make all efforts possible to avoid these 
infections. Healthful living, fresh air, exercises, and gymnastics are essen- 
















419 


THE STANDARD FAMILY PHYSICIAN 


Heart 


tial in developing healthy bodies. Cleanliness of the body and of the dress, 
abstinence from alcoholic drinks, and protective vaccinations are also im¬ 
portant aids. Convalescing individuals should rest in bed as long as pos¬ 
sible, and should carefully avoid even the slightest exertion. In case any 
disturbance of the heart is experienced, the physician should at once be 
notified, no matter how insignificant the matter may seem. 

Although physical exercises in general are beneficial to the development 
of the body, they may exert an injurious influence upon the heart if in¬ 
dulged in to an immoderate extent. Sports which make excessive demands 
upon the activity of the heart should be entirely avoided unless the heart, by 
systematic training, has gradually been rendered equal to the extra exertion. 
Bicycling, rowing, mountain-climbing, etc., may exert a very deleterious 
influence upon the untrained heart, and may often cause permanent injury 
to the organ. Before indulging in any sport, it is therefore advisable to 
submit to a careful medical examination of the entire body. 

Individuals suffering from affections of the heart should exercise great 
care also in the choice of a profession. Even slight valvular defects, which 
are compensated for by an increased activity of the heart, make it neces¬ 
sary to choose professions which do not make excessive demands upon the 
mental and physical activities. A quiet, sedentary occupation, free from 
mental worry and physical exertions, is in order for such patients. Occu¬ 
pations which require great strength, and above all a sound heart, should 
not be selected by individuals suffering from cardiac weakness. The con¬ 
stant and excessive use of drinks (coffee, tea, alcohol), and of tobacco, may 
likewise give rise to harmful consequences. Habitual overindulgence in the 
pleasures of the table is also apt to exert an injurious influence upon the heart. 

The treatment of diseases of the heart should in all cases be entrusted 
to an experienced physician. In addition to sufficient sleep and rest, it is 
of advantage to take moderate exercise in fresh air, with frequent deep in¬ 
spirations, in order to promote the circulation of the blood. The living- 
rooms, and especially the bedrooms, of persons suffering from heart-diseases 
should be large and airy, and must be ventilated several times a day. Equa¬ 
ble climates at moderate elevations are preferable during summer, while 
southern maritime localities are to be recommended in winter. As a rule 
altitudes higher than 4,000 feet are not well stood by patients with weak 
hearts. The selection of a resort had best be left to the physician. 

Cold ablutions with subsequent dry rubbings, and warm baths of about 
86° to 91 0 F. are often of much service. Great extremes of heat and cold 
are to be avoided. The regulation of the stools is of great importance, as 
the straining due to a constipated condition is very harmful to the heart. 
The daily evacuation of the bowels should be assisted by eating a great 
deal of vegetables and fruits, by oil or water enemas, or, if necessary, by mild 

laxatives. 



Heart 

Heat-Stroke 


THE STANDARD FAMILY PHYSICIAN 


420 


Mental or sexual excitement often exerts an injurious influence upon 
patients with heart-disease, and should be avoided as much as possible. 
With reference to women who suffer from heart-affections, the question 
of marriage should be considered, as the possibility of pregnancy, and its 
consequent increased demands upon the heart, is an important issue. When 
the valvular defects are well compensated for, and have caused no dis¬ 
turbances prior to marriage, the presence of a heart lesion is not necessarily 
a bar to marriage. The dangers are by no means as great as they are often 
assumed to be. But they may be called forth by repeated pregnancies, 
by mental emotions, and by physical overexertions. In such cases a ra¬ 
tional mode of living, a well-regulated diet, and careful medical supervision 
are absolutely essential. If albumin is present in the urine of a pregnant 
woman affected with heart-disease, it is advisiable that she drink from one 
to one and a half quarts of milk daily during the first six months, and two 
quarts daily during the last three months, even if the affection does not 
cause her any uneasiness. The urine should be frequently examined by 
the attending physician. 

The dress should be neither too warm nor too light; and it should not 
in any way interfere with respiration or with circulation. Tight skirt- 
bands, corsets, tight garters, and narrow shoes interfere with the vital func¬ 
tions, and should not be worn by patients with weak hearts. 

The diet should be carefully regulated. In affections that run a rapid 
course it should consist principally of milk, soft-boiled eggs, and rice boiled 
in milk. Strong soups, beef-tea, etc., are liable to irritate the heart. When 
the normal function of the heart has been restored, readily digestible, 
nourishing foods should be taken. Overfilling the stomach should be 
avoided, especially before retiring. Highly seasoned or fatty dishes, as well 
as starchy foods, should be omitted from the dietary of patients with weak 
hearts. Boiled milk, and fresh water (pure or mixed with fruit-juices) may 
be taken in moderate quantities. Mineral waters with excess of carbonic 
acid gas, strong coffee and tea, and all beverages containing much alco¬ 
hol are strictly prohibited; the use of tobacco should likewise be entirely 
abandoned. 

During attacks of palpitation, spasm of the heart, or shortness of breath, 
the patient should be given plenty of fresh air before the arrival of the phy¬ 
sician. He should be divested of all tight garments, should occupy a half 
reclining posture, and remain absolutely quiet. Cold compresses or ice- 
bags may be placed upon the chest over the heart region. In marked 
palpitation of the heart, and in cases of constant painful or oppressive sen¬ 
sations in the cardiac region, the application of pressure to the chest in the 
region of the heart often proves beneficial. Sudden weakness of the heart, 
with a tendency to fainting, requires the administration of strong black 
coffee, brandy, or wine. It is advisable also to rub the body with hot towels, 

















421 


THE STANDARD FAMILY PHYSICIAN 


Heart 

Heat-Stroke 


or to apply mustard-poutices or plasters to the region of the heart. Hot 
foot-baths or hand-baths also have a .favorable action. 

In addition to the general directions for patients suffering from heart- 
diseases, a number of special treatments are of service; the selection of 
these, as well as of the medicines, must, however, be left to the physician. 
Among climatic resorts worthy of recommendation may be mentioned the 
following. In Europe: Nauheim, Cudowa, Franzensbad, and Marienbad. 
In the United States: Hot Springs, Va.; Mt. Clemens, Mich.; Glenwood 
Springs, Col., and Watkins Glen and Dansville, N. Y. The saline sulfur 
baths of Frenchlick Springs (Indiana) are advisable, especially for patients 
afflicted with heart-diseases which continue to cause disturbances (such as 
palpitation, oppressions, shortness of breath, etc.) although the defect has 
been compensated for by increased cardiac activity. 

Among other special methods of treatment, mention may be made of 
dietetic cures (milk, whey, or grapes), which are especially indicated in 
patients who are inclined to obesity; mechanical treatment with massage 
of the chest, arms, and legs, in order to facilitate the circulation of blood; 
and resistance gymnastics. The pharmacopoeia also contains excellent rem¬ 
edies which, by increasing the blood-pressure and strengthening the heart, 
are capable of removing even severe symptoms of cardiac weakness. 

HEARTBURN.—An accompanying symptom in various diseases of the 
stomach. It consists in a disagreeable burning sensation in the esophagus, 
accompanied with sour eructations which are repeated every few minutes. 
As a rule this belching is most severe directly after a meal, and it may con¬ 
tinue for an hour or more. The cause of heartburn is the development in 
the stomach of abnormally large quantities of acids (particularly hydro¬ 
chloric acid), due either to fermentation of food or to abnormal irritation 
of the nerves which cause the elaboration of the gastric juices. 

Since heartburn is a symptom only, and not a disease in itself, it follows 
that treatment must be directed to the fundamental causes. To diagnose 
these is the mission of the physician. Great care should be exercised with 
regard to the diet, and as a general rule it may be said that fatty foods, acid 
drinks, spices, onions, cheese, radishes, eels, salmon, crabs, lobsters, coffee, 
and alcoholic drinks are to be avoided. Bicarbonate of soda affords im¬ 
mediate relief in this condition, but should not be used to excess. The 
treatment had best be left to the physician. 

HEAT-STROKE.—A transitory, morbid condition brought about by 
overheating the body in consequence of excessive muscular activity in hot 
and sultry air. It occurs principally as a result of forced marching and 
during exhaustive work in very warm weather. In contradistinction to 
Sunstroke (which see) it may occur also when the skies are clouded. Per¬ 
sons affected by heat-stroke become unconscious, are attacked by convul¬ 
sions, and have excessively high temperature. 




Hemlock-Poisoning THE STANDARD FAMILY PHYSICIAN 


422 


A patient suffering from a heat-stroke should immediately be placed 
in a shady place with his head in an elevated position. If necessary, shade 
must be produced by the aid of umbrellas or other suitable objects. The 
patient’s garments should be loosened, and he should be vigorously fanned. 
It is desirable to pour cold water over him, or to apply ice-bags to the head 
and to the region of the heart. If the patient is able to swallow, cold water 
may be given in large quantities. In severe cases artificial respiration may 
be necessary. 

In order to prevent heat-stroke it is necessary to drink plenty of water 
during a march or when working, to rest as often as possible in shady and 
airy places, to wear loose-fitting garments, to cool the head by frequent 
flushings with cold water or by fanning, and, above all, to avoid alcohol in 
any form. If dizziness or other signs of weakness appear while walking or 
working, immediate rest is requisite. 

HEDEOMA (PENNYROYAL).—The dried leaves of Hedeoma puleg- 
ioides, a low annual herb found throughout the eastern portion of the United 
States. It contains a very active volatile oil, rich in phenols; and it has a 
very marked action on the lower intestinal canal as well as on the uterus. 
It has been widely used as an aromatic for stomach disorders, and at times 
it has been foolishly employed by the laity for the purpose of inducing abor¬ 
tion. Used for this purpose it is successful in causing very severe poisoning 
without bringing about the desired result. 

HEMATEMESIS.—Vomiting of blood, resulting from the rupture of a 
blood-vessel in the wall of the stomach. The expelled blood is usually dark 
in color and somewhat lumpy. The amount of blood vomited varies greatly. 
Sometimes mere traces are present in the vomitus; in other cases it appears 
in drops or streaks; at other times quantities varying from a teaspoonful 
to a cupful may be vomited; and in certain instances as much as a quart 
of blood has been observed. Very often the blood is mixed with mucus or 
with particles of food; it may, however, be vomited perfectly clear, and is 
then of a pronounced dark red color. It may be difficult even for a practised 
physician to decide whether such an expulsion of blood emanates from the 
stomach or from the lungs. Gastric hemorrhages usually result from the 
destruction of a gastric blood-vessel by an ulcer of the stomach; but they 
may be due also to a congestion of blood in the stomach, such as frequently 
occurs during a diseased condition of the liver. Part of the blood finds its 
way into the intestine, and produces dark discoloration of the stools. 

In the presence of a gastric hemorrhage the first thing to be done is to 
put the patient to bed and insist on absolute rest in order to avoid further 
loss of blood, which under certain circumstances may endanger life. The 
patient should remain in bed for two or more days according to the severity 
of the bleeding. An ice-bag may be placed over the stomach, and ice ad¬ 
ministered in small pieces. The diet should preferably consist only of very 








423 


THE STANDARD FAMILY PHYSICIAN 


Hedeoma 

Hemlock-Poisoning* 


cold milk in small quantities. The administration of hemostatic drugs 
must be left to the physician. The condition of anemia which is sure to 
follow such hemorrhages, and which sometimes persists for weeks and 
months, requires particular attention according to the principles laid down 
for the treatment of this affection (see Anemia). A physician’s aid is 
indispensable. 

HEMATURIA.—Hemorrhage from the mucous membranes of the 
urinary passages, usually from the kidneys, ureters, bladder, or urethra, in 
the order named. The presence of blood in the urine gives the latter a 
dirty red color. Hematuria is a sign of varied importance. It occurs regu¬ 
larly in acute inflammations of the kidneys; less often in the chronic cases 
of this disease. Other diseases which may be accompanied by hematuria 
are: Renal tuberculosis and cancer, stones in the kidney, many cases of 
poisoning, severe cystitis, vesical calculi, tumors of the bladder, and rup¬ 
tures of dilated blood-vessels in the bladder. A bloody condition of the 
urine is endemic in certain countries, such as Egypt, where it is due to the 
presence of parasitic worms ( Bilharzia ) in the blood-vessels of the bladder, 
these parasites depositing their eggs in the mucous membranes of the urinary 
passages. The symptoms may be caused also by the presence in the urine 
of dissolved hemoglobin. 

HEMERALOPIA.—Night-blindness. This condition is due to a mor¬ 
bid, sometimes congenital, affection of the retina and optic nerve, which 
causes the eye to become insensitive to dim light, so that vision is totally or 
partially lost as soon as twilight sets in. The condition may be due to 
prolonged exposure to very brilliant light, or it may be caused by disturb¬ 
ances of nutrition. As a rule there are no evidences of this disease visible 
under the ophthalmoscope. Hemeralopia may occur in soldiers marching 
for a considerable length of time in strong sunlight, or in firemen working 
continuously in front of a furnace. It is of more frequent occurrence in the 
tropics than in temperate zones. 

HEMLOCK-POISONING.—A characteristic form of poisoning caused 
by eating the poison hemlock (Conium maculatum) which may be confused 
with parsley, celery, or parsnip. The symptoms are vomiting, pains in the 
stomach and intestines, staggering, dizziness, a sensation of cold and of 
heaviness, and paralysis of the legs and of the muscles governing respira¬ 
tion. The treatment consists in the administration of enemas and of 
artificial respiration. 

The withered leaves of hemlock have a disagreeable smell, resembling 
that of mice. Its root is cylindrical, fibrous, hollow, and divided into par¬ 
titions by transverse walls. The taste is at first sweetish, later acrid. Pars¬ 
nip and parsley have fleshy roots of a sweet, aromatic taste, the dried lea\es 
of the latter have no smell. The root of celery is round (turnip-shaped) 
and of a sweet taste. Compare illustrations on Plate XXIII. 



Hemophilia 

Hemorrhage 


THE STANDARD FAMILY PHYSICIAN 


424 


HEMOPHILIA.—Term referring to a rather uncommon condition which 
is characterized by such a marked tendency to hemorrhage that even a 
slight wound in any part of the body may cause the individual to bleed to 
death. The real cause of this strange condition has never been satisfactorily 
explained. Although numerous observations have shown that extraor¬ 
dinary thinness of the walls of the blood-vessels, and their consequent 
liability to become readily ruptured, may partly account for the produc¬ 
tion of these hemorrhages, there is no doubt that this cause is supplemented 
by some abnormal condition of the blood whereby its ability to coagulate 
is impaired to such an extent that small openings in the blood-vessels are 
not closed by clots as occurs under normal circumstances. All observers 
agree, however, that the disease is hereditary in character. Cases are known 
of entire families in whom the tendency seems to have been transmitted 
through a healthy mother to her sons, while the daughters have remained 
unaffected, although they later have become the mothers of sons who were 
likewise afflicted. 

Hemophilia seems to be especially a condition of early childhood and 
adolescence, gradually abating later in life; and if proper precautions are 
taken to protect such children they may attain a ripe age in spite of their 
affliction. Preventive measures are, in fact, the main essentials in these 
cases. The patient must be warned that the slightest prick with a needle 
or a pin, active brushing of the teeth, or continued sneezing or hawking, 
may cause a hemorrhage so serious that it may baffle every known method 
of relief. In these cases even small hemorrhages must be regarded as se¬ 
rious, and a physician called at once. General good health and a sensible 
mode of life greatly aid in diminishing the tendency to such abnormal bleed- 
ing. Internal hemorrhages are less frequent, but must nevertheless be 
guarded against. It is ordinarily sufficient that the subject of hemophilia 
be warned against the dangers attendant upon wounds of even the smallest 
blood-vessels, such as may be produced by perforating the ears, by minor 
operations, or even by corporal punishment. For this reason it is well to 
notify the instructor of such a child of its condition, and to see to it that 
especial precautions be taken during gymnastic exercises. In order to 
avoid extensive dental operations, the mouth and teeth should be thoroughly 
cared for from early youth. In choosing an occupation, such callings 
should be avoided in which injuries (even of a minor character) are liable 
to occur, and those selected which call for but little bodily exertion. Pa¬ 
tients suffering from this condition should never be permitted to enter 
military service. 

HEMOPTYSIS.—Coughing of blood. Blood may be coughed up with 
the sputum in the form of little specks or streaks, or it may be found thor¬ 
oughly mixed with the sputum. Sometimes the expectoration consists en¬ 
tirely of blood. Blood from the lungs may be distinguished from bloody 






425 


THE STANDARD FAMILY PHYSICIAN 


Hemophilia 

Hemorrhage 


vomit by the fact that blood from the stomach is dark red and lumpy, whereas 
that derived from the lungs is bright red and frothy. Furthermore, the blood 
coming from the lungs is expelled by coughing, while that from the stom¬ 
ach is vomited. Mistakes may readily occur, as blood coming from the 
nose, pharynx, or gums, may be first swallowed and then vomited. Even 
the most careful examination may sometimes fail to reveal the true state of 
affairs. The coughing of blood is usually a result of pulmonary tuberculosis, 
in which disease it is produced by the rupture of blood-vessels in the lung. 
The sudden appearance of blood in the sputum of an apparently healthy 
person may often serve as the first indication of the presence of this disease. 
Among other, more or less common, causes of hemoptysis may be men¬ 
tioned severe irritation of the mucous membrane of the bronchi, injuries to 
the respiratory organs (such as contusions of the chest, or fracture of the 
ribs), certain diseases of metabolism (such as purpura and scurvy), rupture 
of the aorta into the respiratory passages, and tumors or parasites in the 
lungs. Mere bloody stains in the expectoration may occur from numerous 
other causes. 

Preliminary to an attack of hemoptysis the patient experiences a feeling 
as if a warm fluid were making its way up behind the breast-bone. This is 
followed by a sweetish or salty taste in the mouth, whereupon the blood is 
brought up by hawking or coughing. Some persons are thrown into a 
paroxysm of fear on the appearance of even slight traces of blood in their 
sputum. Although this fear is often unfounded, it is wise to submit to a 
careful physical examination by a physician, in order that the patient may 
be reassured if no danger be present, or that prompt treatment may be 
instituted if necessary. 

Although rarely fatal, hemoptysis should always be regarded as a serious 
symptom which requires immediate medical attention. Before the arrival 
of the physician, the patient should observe absolute rest, preferably in bed; 
he may take small pieces of ice, very cold lemonade, or salt water (2 to 3 
teaspoonfuls to the glass). The tendency to cough should be repressed. 
Hot drinks and alcoholic beverages must be entirely omitted. The various 
teas recommended for this condition on account of their pretended astrin¬ 
gent action are absolutely useless. The fact that the most severe hemor¬ 
rhages come from ruptured vessels, which have entirely lost the powei to 
retract, makes it plainly evident that such recommendations arc entirely de¬ 
void of a scientific basis. In the presence of constantly recuning hemor¬ 
rhages it is advisable to apply fairly tight bandages aiound the middle 
portions of the arms and legs. These bandages produce congestion, thus 
reducing the blood supply of the lungs to a certain extent. 

HEMORRHAGE AND ITS CONTROL.— Hemorrhage is the general term 
for bleeding, or for a loss of blood, from the blood-vessels. Distinction must 
be made between internal and external hemorrhages. The loss of blood 





Hemorrhage 


THE STANDARD FAMILY PHYSICIAN 


426 


may be slight, as in the cases of nosebleed 
and insignificant cuts; or it may be extensive, 
as in the bleeding that may occur from ulcer 
of the stomach. Hemorrhage may be a 
normal physiological process (as, for in¬ 
stance, the recurring bleeding of menstrua¬ 
tion), but in the great majority of instances 
it is a pathological process. Many persons 
bleed very freely on slight provocation, and 
are always in danger of fatal hemorrhage. 
See Hemophilia. 

The causes of hemorrhage are very nu¬ 
merous, but for the layman the most im¬ 
portant types of bleeding are those due to 
accidental cuts. Here it is essential to rec¬ 
ognize the character of the blood-vessels in¬ 
jured, whether veins or arteries. The so-called “blue venous blood” is 
largely a fiction. The difference in color of venous blood and arterial blood 
is in reality very slight, and as oxygenation rapidly takes place in the air, 
venous blood (which is only a shade darker than arterial blood) is rendered 
lighter. If the injured blood-vessel be a superficial one, the difference 
between the steady oozing 
from a vein (see Fig. 219) and 
the pulsating outflow from an 
artery (Fig. 220) is readily 
perceived; but if the wound 
be deep and partly blocked 
by clots and cut flesh, the pul¬ 
sations from a bleeding artery 
may not be readily noticed. 

In attempting to stop a flow 
of blood it is of importance to 
remember that in veins the 
current of blood is in a direc¬ 
tion opposite to that in the 
arteries. In the latter vessels 
the blood is propelled inter¬ 
mittently away from the heart 
toward the extremities; in the 
veins it flows uninterruptedly 
from the extremities toward 
the heart. Therefore, when 
it has been definitely deter- 



Fig. 220. Bleeding from an artery. 



Fig. 219. Bleeding from a vein. 





427 


THE STANDARD FAMILY PHYSICIAN 


Hemorrhage 


mined whether an artery or a vein has been cut, compression must be made 
accordingly. If an artery has been injured, compression must be made on 
that side of the wound which is nearest the heart; if a vein, on that side of the 
wound which is furthest away from the heart. When both types of vessels 

have been severed by the same cut, compression on both sides of the wound 
may be necessary. 

In the case of every bleeding injury, great care must be taken not to 
infect the wound. Whatever comes in contact with the wound (whether 



Fig. 22i. Application of bandage to arrest bleeding. 

it be the hands, the dressing-material, or the bandages) must be thoroughly 
cleansed and, if possible, sterilized. A moderate bleeding may be stopped 
by applying a compress of surgical cotton or gauze to the wound, holding 
it in place with the fingers or with a snug bandage. If neither cotton nor 
8 is at hand, a piece of clean linen, or a handkerchief folded several 
5 , may be used. The application of various remedies, such as pumice, 
ters, cobwebs, etc., is dangerous rather than helpful, and should be 
ded. 

f the bleeding can not be controlled by the means just noted, it may 
possible to do so by applying a suspender, a handkerchief, or a bandage 

















Hemorrhage 


THE STANDARD FAMILY PHYSICIAN 


428 


made from any material immediately at hand, around the injured limb 
(see Fig. 221). If greater pressure is desired, a lever may be inserted under 
the knot of the bandage, and a still greater constriction secured by twisting 
this (see Fig. 222). If the injured vessel be an artery, the pressure should 
be applied above the site of the wound. Where the hemorrhage takes place 
from a vein, the bandage must be applied from the hand or foot upwards, 
to a point above the wound, which is covered with a pad of gauze or cotton. 

In localities where no 
bandage can be applied, 
the control of hemorrhage 
is a more difficult matter. 
In such cases it is advisa¬ 
ble to press the bleeding 
artery against a neighbor¬ 
ing bone with the finger. 
When the bleeding occurs 
on the forehead, the tem¬ 
poral artery may be com¬ 
pressed just in front of the 
ear (see Plate VII.); when 
it takes place from the 
neck, the carotid artery 
may be compressed in the 
groove between the larynx 
and the vertebral column 
(see Fig. 223); and if the 
hemorrhage occurs on the 
shoulder or in the axilla, 
it may be controlled by 
compressing the subclavi¬ 
an artery, and at the same 
time draw the arm down¬ 
ward against the first rib 
(see Figs. 224 and 225). In hemorrhage from the thigh, the femoral artery 
can be pressed against the pelvic bone in the middle of the groin, when the 
leg is half bent. The best place on which to apply pressure on the upper 
arm is along the inner side, just below the biceps (see Fig. 226). A similar 
effect may be secured by compressing the upper arm between two sticks 
applied as shown in Fig. 227. Pressure for this purpose must not be kept 

up for a longer period than three or four hours; otherwise gangrene is 
apt to set in. 

If an injured person be very much weakened from loss of blood, and is 
in a fainting condition, he should be given strong black coffee, wine, rum, 










429 


the standard family physician 


Hemorrhage 


whisky, or brandy. The head should be kept in a low position, and spirits 
of ammonia should be applied to the nostrils for inhalation. 

Hemorrhage is a frequent complication of a number of diseases. The 



Fig. 223. Pressure on the carotid artery. 


Fig. 224. 


Pressure on the subclavian artery. 


most important of these are ulcer of the stomach, cancer of the s'omach, 
cancer of the intestine, tuberculosis of the lungs and of the throat, typhoid 
fever, and diseases of the womb. In ulcer of the stomach characteristic 
symptoms are present; such as pain, 
vomiting of food or of blood, or blood in 
the stools. Skilled medical advice is 
needed to stop the bleeding from an ulcer 
of the stomach, and the only help that 
the patient can offer before getting treat¬ 
ment is to keep as quiet as possible and 
take nourishment by the rectum only. 

Even water should not be swallowed. 

In cancer the diagnosis should be made 
early if medical help is to be of any avail. 

The symptoms of this condition are nau¬ 
sea, vomiting, loss of appetite, loss of 
weight, blood in the vomit or in the 
stools, and progressive anemia. If rec- 

Ognized early a surgical operation may p IG . 225. Compressing the subclavian artery 
save the patient’s life; otherwise no help by drawing the arm against the ribs - 
is possible. The diagnosis of hemorrhage from the bowels is not readily 
made. When the blood is bright red the probabilities are that the 
hemorrhage is taking place low down in the large intestine. If the stools 
be black and tarry the inference is that the hemorrhage is from the upper 








iaemorrnage 

Hemorrhoids 


THE STANDARD FAMILY PHYSICIAN 


430 


portions of the intestinal tract—the stomach, duodenum, or other portions 
of the small intestine. Any patient passing a black, tarry stool should keep 
such a stool for the inspection of his family physician, as hemorrhage from 
the bowel is often the early sign of gastro-intestinal cancer. The treatment 
of these affections is always surgical. 

Hemorrhages from the throat and mouth always merit careful attention. 
Bleeding from the posterior part of the nose is often mistaken for bleeding 
from the lung; and occasionally blood that is vomited is thought to be 
coughed up. In true throat and lung hemorrhages the blood is usually 
bright red, and comes up either in small quantities or in large amounts. 




Fig. 226. Applying pressure on upper arm Fig. 227. Exerting pressure on upper arm 
to stop bleeding. by mea ns of two sticks. 

Such hemorrhages aie due to the rupture of smaller or larger blood-vessels 
in the thioat or in the lungs, and are important signs of pulmonary tuber¬ 
culosis. The immediate treatment of such hemorrhages consists of rest, 
light diet, and some sedative. A small dose of opium is frequently helpful 
until the physician arrives. Not more than half a grain should be given. 

Sudden pcifoiation of an intestinal ulcer, with severe bleeding, is one of 
the grave accidents of typhoid fever. It usually occurs in the third or fourth 
week of the disease, and is evidenced by sudden spells of weakness, and by 
the presence of tarry or reddish material in the stools. In some cases surgi¬ 
cal intervention is essential for the preservation of the patient’s life; but 
many recover without surgical aid. The question of operation should not 
be lightly considered. Strict dietary treatment and absolute bodily rest are 
the first aids in this severe accident. See also the articles Bloodletting; 
Bladder, Diseases of; Brain, Apoplexy of; Menstruation; Stomach, 
Diseases of; Womb, Diseases of. 



431 


THE STANDARD FAMILY PHYSICIAN 


Hemorrhage 

Hemorrhoids 


HEMORRHOIDS. -Nodular swellings of the blood-vessels (veins) at 
the lowest point of the rectum, inside or outside the anus. The disease, 
which is of very frequent occurrence in both sexes, generally sets in after 
the thirtieth year of life, although it may occur earlier. The significance of 
hemorrhoids is usually greatly overrated among the laity. The obsolete 
and erroneous opinion that hemorrhoids affect internal organs is widely 
disseminated; and the belief that these swellings were due to a disease has 
occasionally been the cause of serious consequences. It can not be too 
strongly emphasized that hemorrhoids are absolutely nothing but a local 
affection of the rectum, caused by the sluggish flow of the blood from this 
part of the body because of its distance from the heart. The blood over¬ 
fills the veins, and swellings take place as a consequence. 

The swellings, which at first may be the size of a small shot or a cherry¬ 
stone, may gradually attain the size of a plum, and are superabundantly 
filled with blood. Sometimes these swollen vessels surround the anus in 
the form of a ring, being arranged like a string of beads. In some cases 
only a single node is visible; in other cases several swellings are closely 
associated. The hemorrhoids are of a bluish-red color. In some cases they 
are located so deeply within the anus that they are not visible externally, 
and can merely be felt with a finger in the interior of the rectum. Such 
internal piles or hemorrhoids are sometimes present in addition to others 
which may be seen and felt externally. The distended blood-vessels do 
not always form nodular swellings, but frequently permeate the entire mu¬ 
cous membrane of the rectum as thick cords, their upper ends being visible 
only by aid of the rectoscope. 

Hemorrhoids are very obstinate to treat. They develop very slowly 
and gradually, and may cause no disturbances until months or years have 
passed. It often happens that the first manifestation of the affection con¬ 
sists in hemorrhage from a ruptured node. The bleeding may consist of a 
few drops only; or as much as several teaspoonfuls, or even tablespoonfuls, 
may be passed. The hemorrhage generally recurs after days, weeks, or 
months. Some hemorrhoids bleed almost uninterruptedly for years, 
thereby often causing severe anemia, and pallor of the entire body. Another 
danger of such frequent hemorrhages lies in the fact that they weaken the 
resistance of the body, especially of the heart. The hemorrhages generally 
occur during defecation, owing to the strong downward and outward pres¬ 
sure of the rectum. Unfortunately, patients suffering with hemorrhoids are 
usually constipated, and are therefore compelled to strain very much at 
stools. 

In addition to bleedings, hemorrhoids cause various other disturbances, 
such as frequent desires to evacuate the bowels, painful defecation, itching, 
and the passage of mucus and pus in consequence of frequently occiuring 
inflammations of the mucous membrane of the rectum. It happens at 





Hemorrhoids 

Heredity 


THE STANDARD FAMILY PHYSICIAN 


432 


times that hemorrhoidal swellings become caught by the ring-muscle (sphinc¬ 
ter) of the anus, so that they can be replaced in the rectum only with 
difficulty. Hemorrhoidal nodes which are situated outside the anal opening 
are always exposed to the danger of bacterial infection. They become in¬ 
flamed, swell, suppurate, and may even become gangrenous. In that case 
they are a torture to the patient; and they interfere with walking, standing, 
sitting, and lying, still more than external hemorrhoids are prone to do under 
ordinary conditions. The irritation caused by the discharges from the rec¬ 
tum occasionally gives rise to considerable soreness of the skin surrounding 
the anus. 

Hemorrhoids sometimes result from general disturbances of circulation 
(principally from heart-defects and diseases of the liver) which cause con¬ 
gestions of the blood-vessels, especially of the abdominal vessels. More 
frequently, however, they are due to purely local congestions, arising, for in¬ 
stance, in consequence of a sedentary occupation or of constipation. For 
this reason constant constipation is looked upon as one of the most frequent 
causes of hemorrhoids. The pernicious habit, met with especially in girls 
and women, of suppressing the stools on account of modesty, etc., often 
leads to severe constipation. The pressure of the fecal masses upon the 
blood-vessels causes distention and hemorrhoids. 

It is easier to prevent hemorrhoids than to heal them. The principal 
condition is strict cleanliness of the anus, especially after evacuations of the 
bowels. Regular movements must be carefully attended to. If there is a 
tendency to constipation it is necessary to stimulate evacuation by observ¬ 
ing care with regard to the diet, by physical exercise, or by taking laxatives 
or enemas. Regular and loose evacuations of the bowels are of the great¬ 
est importance for patients suffering from hemorrhoids. The anus should 
be carefully cleansed after evacuations by washing it with a sponge and 
drying it with a soft piece of gauze (paper should not be used), whereupon it 
should be greased with lanolin or vaselin. Prolapsed nodes should be 
pushed back with the fingers, care being taken that the nails are not long 
enough to injure the parts. In cases of constricted hemorrhoids cooling 
compresses made of aluminum acetate or of weak lead-water may be ap¬ 
plied; warm sitz-baths of from 15 to 20 minutes’ duration are also advisable. 
When several nodes are present, particularly if they are large, their removal 
can be accomplished only by surgical interference. 

Bleeding resulting from hemorrhoids may be stopped temporarily, or 
e\en permanently, by internal styptics. More severe hemorrhages require 
local tieatment consisting in cauterization of the bleeding parts, or in 
packing the rectum with iodoform-gauze. This, of course, is to be done 
by fh e attending physician. Cold sitz-baths often cause the vessels to con 
tract so as to diminish the tendency to hemorrhages. These baths also act 
fa\orably upon the weakened intestine and upon the constipation. Open, 







433 


THE STANDARD FAMILY PHYSICIAN 


Hemorrhoids 

Heredity 


contaminated, and suppurating hemorrhoids must be treated by a physician 
according to modern methods. Dusting-powders or salves may be applied 
in order to alleviate the soreness of the skin in the neighborhood of the anus. 
Smaller nodes may occasionally be caused to contract and disappear by in 
jections of carbolic acid; but larger ones can be removed only by extensive 
operations (cauterization, cutting, etc.). This is the only sure remedy. 
The numerous salves which are constantly being placed on the market, pur¬ 
porting to cure hemorrhoids without the knife,’’ are often very unsafe 
remedies. 

HENBANE.—See Hyoscyamus. 

HERB-BATH. This is prepared by adding to the bath a decoction of 
aromatic herbs, the composition of which must be given by a physician. 
As an example may serve a combination of eight ounces each of camomile, 
peppermint leaves, and calamus root, boiled in two quarts of water and 
added to a full bath of a temperature of 95 0 F. This bath is suitable for 
women and children in conditions of irritation. 

HEREDITY.—The transmission from parent to child of physical and 
mental characteristics, as well as of such peculiar traits and tendencies as are 
known by the term “idiosyncrasies.” The inheritability of physical and 
mental qualities is evidenced in every family, but is not equally marked in all 
instances. As a general rule it may be said that these traits are transmitted 
through the generations in three distinct ways: (1) Transmission may take 
place directly from parents to offspring, the qualities of the former blending 
harmoniously in the child. This is called direct heredity. (2) The child may 
inherit the qualities of a more or less remote ancestor, either of the paternal 
or of the maternal line ( normal heredity). (3) The physical and mental 
characteristics of an aunt, uncle, grandaunt, or granduncle may be inherited 
by a nephew or niece ( collateral heredity). In addition to these three main 
avenues of heredity, there are various deviations, such as the inheritance by 
a child of all the qualities of one parent, but none of those of the other’s; or a 
lack of blending in the child of the characteristics inherited, the maternal 
and the paternal traits being individually and distinctly traceable. 

The inheritability of morbid tendencies is a question which can only be 
briefly touched upon in this place. Severe constitutional diseases, such as 
tuberculosis, syphilis, etc., are often transmitted directly from parent to 
child; and for this reason persons suffering from such diseases should feel 
morally obliged to forego marriage. A morbid taint on the part of the 
mother often seems more apt to be transmitted to the male offspring, while 
that of the father is chiefly inherited by the daughters. It must be pointed 
out that many diseases which are loosely spoken of as “hereditary,” are in 
reality acquired by extraneous means, the fetus being infected with the virus 
of the parent’s affection. Such diseases are properly termed “congenital. 
Evolutionary heredity is the term applied to the transmission to the fetus of 







Hernia, q^HE STANDARD FAMILY PHYSICIAN 4o4 

riip-J oint _ 

some moral or physical quality, owing to an extraneous cause affecting the 
mother. 

Heredity is one of the most prominent among the factors causative of 
mental diseases. Such an inherited taint may remain dormant in the child 
until called forth by extraneous influences. The children of mentally de¬ 
ranged parents, or of epileptics or alcoholics, aie \ciy apt to be thus tainted, 
and the trait may even remain dormant in one generation to assert itself in 



Fig. 228. X-ray picture showing dislocation of the right hip-joint. 
Star indicates position of socket. 


the grandchildren of those originally afflicted. In many cases children with 
inherited taints may, by extreme watchfulness and care, be saved for useful 
lives, but in the larger number of instances some external factor generally 
brings out the inherited predisposition. 

HERNIA. — See Rupture. 

HERPES.—A general term applied to a variety of skin eruptions. Herpes 
labialis, or fever-sores, are usually due to digestive disturbances. This 
condition is best treated by taking a saline laxative, and by using an anti¬ 
septic local application, such as carbolic salve, camphor salve, etc. Herpes 
Zoster consists of an acute outbreak along a nerve-trunk of smaller or larger 
blisters, accompanied with pain. The blisters may coalesce and inflame, 
or they may remain separate and slowly dry up. This is a nervous affec- 








435 


THE STANDARD FAMILY PHYSICIAN 


Hernia 
Hip-Joint 


tion, and is at times influenced also by intestinal disturbances. For Herpes 
tonsurans see Ringworm. 

HICCUP (HICCOUGH).—A condition due to spasmodic contractions of 
the diaphragm, caused by irritation of the diaphragmatic nerves. The 
clicking sound characteristic of hiccup is produced by the abrupt closure of 
the vocal cords after each indrawing of air. In little children hiccup may 
often be checked by means of a snug bandage around the abdomen; or (in 
children more than one year of age) a drop or two of Hoffmann’s anodyne may 
give relief. In adults the condition is frequently due to some disturbance 
of digestion, which may be readily relieved by taking a teaspoonful of Hoff¬ 
mann’s anodyne. In most cases hiccup is but a trivial affection, which 
usually passes off of its own accord in a few minutes. 

HIP-JOINT, CONGENITAL DISLOCATION OF.—A malformation of 
the hip-joint, in which the head of the thigh-bone, instead of being situated 
in its socket in the pelvis, is placed outside the 
socket, either in front of it or behind. The deform¬ 
ity may affect one or both sides; and girls are more 
frequently afflicted than boys. If the defect be 
not treated it results in marked disturbances of 
walking. A one-sided dislocation (see Fig. 228) 
makes one leg shorter than the other—sometimes 
very considerably so—and the patient limps very 
conspicuously. A dislocation of both sides (see Fig. 

229) does not produce a limp, as both legs are affec¬ 
ted equally much. The walk, however, becomes 
clumsy and waddling because the heads of the 
thigh-bones are not supported in their sockets. The 
pelvis is depressed, the lumbar region of the back 
becomes hollow, and the projecting heads of the 
thigh-bones form humps on the buttocks. Patients 
suffering from dislocation of the hip-joint are un¬ 
able to walk very much; they tire readily even if 
they suffer no pain. 

Formerly it was not thought possible to do much 
toward relieving this condition, and treatment was 
restricted to the wearing of thick-soled shoes, and of 
corsets and apparatus. At the present time, how¬ 
ever, the defect is treated operatively, usually by 
the so-called ‘‘bloodless” operation, which consists 
in reducing the dislocation by manual strength (the patient being un ei 
the influence of an anesthetic), whereupon the limb is placed m a plas- 
ter of Paris cast to hold it in position. It is desirable to correct t e 
deformity as early as the first or second year; and the parents of a child 








Hip-Joint 
Hoffmann 


THE STANDARD FAMILY PHYSICIAN 


436 


that limps should not delay to have it examined by a physician. In some 
cases an open operation will be found necessary, but only a surgeon is able 
to decide this point. 

It should be remembered that a normal gait is not always obtained. Im¬ 
provement is the rule. Complete success is sometimes rendered impos¬ 
sible by the structure of the head of the thigh-bone, and by the circumstance 
that the socket is too small to hold the head of the bone. 

HIP-JOINT INFLAMMATION.—This disease is most frequently caused 
by tuberculosis, although it may be due also to other causes, such as infec¬ 
tious diseases (scarlatina, typhoid fever, gonorrhea), or purulent inflamma¬ 
tion of the marrow in the thigh-bone (osteomalacia). The affection is ob¬ 
served more often in children than in adults, and is popularly known as 
“voluntary limping.” The first symptoms of the disease are disturbances 
of the motility of the joint, and pain in the knee. It is often the case that 
children with beginning inflammation of the hip-joint complain only of the 
pain in the knee, so that parents believe an inflammation of the knee-joint 
is present. Sometimes there may be only a slight stiffness at the hip-joint. 
If the disease progresses, the joint often becomes entirely immovable, and 
the affected leg appears at first too long, then too short. This alternating 
elongation and shortening of the leg is, however, apparent only. A true 
shortening of the leg can not occur until a later stage of the disease is reached, 
when the head and neck of the femur become destroyed. Often so-called 
cold abscesses develop. These may be located either on the front part of 
the leg, or behind the hip-joint; sometimes they may occur also in the pelvis. 

Hip-joint inflammation is a very protracted disease, which in some in¬ 
stances may cause death by the extension of the inflammation, or by the 
spreading of the tuberculous process to internal organs. Even in cases of 
recovery there usually remains defective motility of the hip-joint or even 
lasting stiffness and limping. 

The more careful the treatment the better the final result. Treatment 
consists in straightening the limb with an extension-apparatus, or with 
plaster of Paris bandages. Abscesses must be opened. Severe destruction 
of the joint necessitates the removal of the diseased bones and the joint- 
capsule. A careful diet is of immense service in this disease. Open air 
living is equally essential. 

HIVES.—A disease of the skin, characterized by the eruption of flat 
blotches, red or porcelain-white in color, and varying in size from that of a 
bean to that of a dollar. The eruptions are variously termed nettle-rash, 
hives, or itching boils. They appear suddenly, burn and itch severely, and 
after a little while they disappear completely without leaving any scars. In 
appearance they resemble the swellings caused by the bite of a bedbug or 
by the sting of an ordinary nettle. Occasionally a single blotch may attain 
an extraordinary size, covering a cheek and both lids of an eye. The rash 





437 


THE STANDARD FAMILY PHYSICIAN 


Hip-Joint 
Hoffmann 


often appears on a portion of the skin where the clothing is apt to press 
somewhat. 

This common and very insignificant sickness, which is accompanied 
by pain and soreness in the limbs, lasts as a rule only a few days. In the 
case of many people it is a regular occurrence after eating strawberries, 
crabs, sea-food, etc., or after taking certain medicines, such as turpentine, 
or copaiba. In other cases it appears without any apparent cause; and 
by continued relapses it may last for months, even for years, and work very 
serious harm. In such cases it is often due to some internal disease, as, for 
instance, of the stomach or of the intestines; sometimes mental emotions 
may be the cause. 

In most cases the itching is the only thing which calls for relief. This 
may be afforded by sponging the parts with cold water, diluted alcohol, 
vinegar, or with spirits of peppermint; by rubbing the itching spots gently 
with a slice of lemon or with a menthol pencil; or by a plentiful application 
of rice-powder. Naturally, anything known to be harmful (such as the 
foods just mentioned) should be avoided; and the patient should beware 
especially of vermin. 

HOARSENESS. —A speech-disturbance occurring as a symptom of 
various affections. There are different degrees of hoarseness, varying 
from a slight dimming of the voice (recognizable only to the experienced 
ear) to a rough and harsh, or even to a jarring, grating, almost soundless 
voice. The most frequent cause of hoarseness is catarrhal inflammation 
of the Larynx (which see). Constant hoarseness is caused by paralysis 
of the Vocal Cords (which see), by polypi of the larynx, by tuberculous 
and syphilitic ulcers, or by cancer of the larynx, etc. If the care of the 
voice is neglected in cases of beginning hoarseness (the patient continuing 
to sing, shout, or speak) the result may be that growths arise on the vocal 
cords and on the posterior wall of the larynx. These can be removed only 
by operative interference. Very strong exertions may even cause hemor¬ 
rhages in the vocal cords, and slight spitting of blood. Staying in dusty, 
hot, or drafty rooms usually aggravates an existing hoarseness, or causes 
a recurrence of a former attack. 

A state of hoarseness not due to disease occurs during the period when 
a change of voice takes place in children. In boys this change lowers the 
voice by one octave; in girls, by three to four notes. If the change of voice 
persists abnormally long (sometimes until the twentieth year), it may often 
be remedied by expert technical speech-exercises. The chronic hoaiseness 
of preachers, teachers, singers, actors, etc., requires skilful medical attention. 

HOFFMANN’S ANODYNE (SPIRITUS uETHERIS COMPOSITUS).— 
Compound spirit of ether; prepared by mixing 325 pa its of ether with 650 
parts of alcohol and 25 of ethereal oil. It is a colorless, volatile liquid, with 
a burning, somewhat sweetish taste, and with the peculiar odor of ethereal 






Homeopathy 


THE STANDARD FAMILY PHYSICIAN 


438 


oil. It is used as a stimulant, as an antispasmodic, and as a pain-allayer. 
In nervous insomnia it has proved of value. The dose is from thirty drops 
to a teaspoonful, given on a lump of sugar or in some sweetened water. 

HOMEOPATHY.—A system of medicine founded by a German physi¬ 
cian, Samuel Hahnemann (1755-1843). Medical literature contains many 
narrations of the untoward effects, some of them of the most serious char¬ 
acter, caused by overdoses of drugs; and not a few instances have been 
recorded where moderate doses have been followed by marked symptoms of 
drug-poisoning in persons said to present an idiosyncrasy for the particular 
drug. Cases of poisoning in the industrial arts—lead-poisoning in type¬ 
setters, blindness following the use of methyl alcohol, etc.—are certainly 
not infrequent. Indeed, many medicinal substances are capable of causing 
disease in healthy persons, when administered in sufficiently large doses. 
And each medicinal substance produces a drug-intoxication peculiar to 
itself. The effects of poisoning by arsenic, by belladonna, and by opium 
can be easily differentiated by the symptoms to which each of these drugs 
gives rise in the subject of the poisoning. Thus, just as symptoms are the 
natural language of disease, so symptoms are the natural language also of 
drug action. The power of a drug to produce departures from normal sen¬ 
sation and normal function, to affect the human economy, can best be 
learned, and can only be learned in its entirety, by studying the symptoms 
it produces when given to persons in health. 

The power of a drug can not be determined as well from the results of 
its administration in disease. Symptoms following its administration may 
be natural modifications arising in the course of the disease; or they may be 
only modifications of the disease-symptoms, and not symptoms produced 
by, and wholly attributable to, the drug. By symptoms is here understood, 
not only the sensations described by the patient, but also all those depar¬ 
tures from the normal which are ascertainable by the most advanced methods 
of diagnosis. Experiments made upon animals can never entirely take the 
place of tests on healthy persons. 

To Samuel Hahnemann belongs the credit of being the first to system¬ 
atically study the powers of medicines in this manner. This he did by 
taking many drugs himself when in health, also giving them to members 
of his family and to his friends, including a number of physicians. The 
elfects produced by the drugs on these healthy persons he very carefully 
recorded and systematically arranged. The whole series of effects pro¬ 
duced by a drug on a healthy individual, he called a “proving” of that drug. 
Out of these provings Hahnemann constructed his Materia Medica, so group¬ 
ing the symptoms produced by each drug in the one or more healthy in¬ 
dividuals who “proved” it, as to present a picture of its disease-producing 
power. Thus, a text-book of homeopathic materia medica does not say that 
a gixen diug is to be prescribed in tnis or that disease; it is simply a col- 




439 


THE STANDARD FAMILY PHYSICIAN 


Homeopathy 


lection of symptoms produced by the drug when administered in varying 
doses to healthy persons of both sexes, of all ages, and of varying tempera- 
ments and susceptibilities. 

In 1796 Hahnemann published in Hujeland’s Journal his essay on a 
“New Principle for Discovering the Curative Power of Drugs.” In the 
course of this article he said: “Every powerful medicinal substance pro¬ 
duces in the human body a peculiar kind of disease—the more powerful 
the medicine, the more peculiar, marked, and violent the disease. We 
should imitate nature, which sometimes cures a chronic disease by super¬ 
adding another, and employ in the disease we wish to cure that medicine 
which is able to produce another very similar artificial disease, and the former 
will be cured— similia similibus .” The rule he here laid down is tersely 
expressed in the well-known motto: Similia similibus curantur , “Like 
[ailments] are cured by like.” 

About 1788 Hahnemann gave up the practise of medicine in disgust at 
the uncertainties of his art, owing to the lack of any principle for the ad¬ 
ministration of drugs in disease. For a time he supported his family by 
translating English, French and Italian works on chemistry, agriculture, 
and medicine into German. In 1790, while he was translating Cullen’s 
Materia Medica, his mind being constantly on the alert for some guiding 
principle for the selection of medicines in disease, he found himself unable 
to accept Cullen’s explanation of the action of cinchona-bark in the cure of 
malaria. He determined to test the action of the drug on himself. He 
says: 

“I took, by way of experiment, twice a day, four drams of good cinchona. 
My feet, finger-ends, etc., at first became cold; I grew languid and drowsy; 
then my heart began to palpitate and my pulse grew hard and small; in¬ 
tolerable anxiety, trembling (but without cold rigor), and prostration 
throughout all my limbs set in; then pulsation in my head, redness of the 
cheeks, thirst, and, in short, all those symptoms which are ordinarily char¬ 
acteristic of intermittent fever, made their appearance, one after another; 
yet without the peculiar, chilly, shivering rigor. Briefly, even those symp¬ 
toms which are of regular occurrence and especially characteristic—as the 
stupidity of mind, the kind of rigidity in all the limbs, but, above all, the 
numb, disagreeable sensation which seems to have its seat in the perios¬ 
teum of every bone in the body—all these made their appearance. This 
paroxysm lasted two or three hours each time, and recurred if I repeated 
the dose; not otherwise. I discontinued, and was in good health.” 

The apparent similarity between the symptoms which the drug pro¬ 
duced and those which it so often removed, set him to thinking, and he 
went to work to test other drugs on himself and on the members of his 
family. The result of these experiments was the formulation of his prin¬ 
ciple for ascertaining the curative power of drugs. In 1807 Hahnemann 








Homeopathy 


THE STANDARD FAMILY PHYSICIAN 


440 


first used the word “homeopathic.” It appears in the title of an essay, 
likewise contributed to Hujeland's Journal, on “Indications for the Homoeo¬ 
pathic Employment of Medicines in Ordinary Practice.” 

Homeopathy is the art of selecting and administering medicines in ac¬ 
cordance with the law or rule of similars. A remedy is homeopathic to a 
given diseased condition when it has produced in the healthy individual 
symptoms similar to those which characterize the condition. According 
to the definition authorized by the American Institute of Homeopathy, “a 
homeopathic physician is one who adds to his knowledge of medicine a 
special knowledge of homeopathic therapeutics and observes the law of 
similia .” A number of homeopathic societies require candidates for mem¬ 
bership to acknowledge that the principle of similia is the best guide in 
therapeutics; but the freedom of a homeopathic physician to follow his 
best judgment in the treatment of patients is in no way hampered. 

Homeopathy must not be confounded with Hahnemann’s philosophy, 
his conception of a spirit-like force residing in drugs, or his psora theory. 
Homeopaths do not claim that the enunciation of the principle of similia 
was original with Hahnemann; he himself traced it to the times of Hip¬ 
pocrates. Similarly, Hahnemann’s philosophy was a development of the 
philosophies of Paracelsus, Van Helmont, Descartes, and Stahl. The idea 
of testing the powers of drugs on the healthy was suggested by Haller. To 
Hahnemann belongs the glory of carrying out Haller’s suggestion and of 
proving the universality of Hippocrates’ observation. 

In the minds of many homeopathy is synonymous with infinitesimal 
doses; and no article on homeopathy is consequently complete that does 
not discuss the question of dose. Susceptibility to the action of different 
drugs varies somewhat in different persons. One person can handle Rhus 
toxicodendron (poison-ivy) with impunity; another is affected by it if the 
wind blows from the plant toward him, even though he be on the other 
side of the road. Susceptibility also varies in the same person at different 
times, especially according to the state of health or disease of the person, 
just as the normal eye can bear the light that is intolerable to one that is 
inflamed. Hahnemann’s experience was that in disease the human body 
is infinitely more susceptible to the action of a drug which is homeopathic 
to the morbid condition, than it is to the action of the same drug when in 
health; it is also, when diseased, infinitely more sensitive to the homeo¬ 
pathic drug than it is to one that is not homeopathic. Hahnemann claimed 
that he could not prescribe the physiological doses of drugs when he was 
administering them according to the rule of similia; and he also demon¬ 
strated that a drug which produced a certain morbid condition, or train of 
symptoms, when given in a large dose, would remove a condition presenting 
similar symptoms, when given in a dose exceedingly small. 

The wonderful facts concerning the phenomena of radio-activity, now 




1 


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PLATE XL —THE NERVES OF THE UPPER HALF OF THE BODY 
( Right lung moved forward and showing section) 


1. Trigeminal nerve 

2. Hypoglossal nerve (motor nerve of the 

tongue) 

3. Pneumogastric (vagus) nerve 

4. Cervical sympathetic nerve 

5. Cervical nerve plexus 

6. Brachial nerve plexus 

7. Intercostal nerves 

8. Intercostal sympathetic nerves 

9. Branches of sympathetic nerve to blood¬ 

vessels 

10. Communicating branch between superior 

and inferior venas cavas 

11. Thoracic duct 


12. Aorta 

13. Diaphragm (cut) 

14. Supraorbital nerve 

15. Infraorbital nerve 

16. Sensory nerve of tongue 

17. Gustatory nerve (nerve of taste) 

18. Pneumogastric (vagus) nerve 

19. Esophagus (gullet) 

20. Pulmonary branches of pneumogastric 

nerve 

21. Pericardium (heart-bag) 

22. Esophageal branches of pneumogastric 
nerve 

Gastric branches of pneumogastric nerve 


23. 

24. Stomach 

( For functions of various nerves, see pp. 65-68 ) 


Plate XI.[i 

*■ i 



















441 


THE STANDARD FAMILY PHYSICIAN 


Homeopathy 


demonstrated day by day by leading scientists, make it easier to conceive 
the power of infinitesimals. Nageli has demonstrated that if metallic copper 
be thrown into water, the water will actually, in the course of time, become 
a solution of copper of the strength of one part copper to 77,000,000 parts 
of water. It is a matter of daily experience, demonstrable by any one who 
will make the test, that the protoplasm of morbid cells in a human body is 
affected by matter too attenuated to be detected by the balance, by the 
chemical test, or even by the spectroscope. 

One and the same drug may be homeopathic to a great variety of dis¬ 
eased conditions. Bryonia produces in the healthy individual sypmtoms 
resembling those sometimes seen in synovitis, constipation, and gastritis. 
It will be homeopathic to any of these diseased conditions if the leading 
symptoms of the case correspond to the characteristic symptoms produced 
by the drug. All symptoms observed in provings are not of equal value in 
making a prescription. When any peculiar effects are seen in a proving, 
these are key-notes when the same symptoms are met with in a case of dis¬ 
ease. Thus the homeopathic physician finds that he has need of a repertory, 
or index of symptoms, as well as of his materia medica. In the repertory 
the names of all the drugs that have produced a given symptom are grouped 
alphabetically under that symptom. Sometimes different forms of type 
are used for the names of the drugs in order to indicate that the symptom is 
more characteristic of one drug than it is of another. 

In determining a prescription the homeopathic physician looks for 
three similarities: (1) between the sensations produced by the drug on the 
healthy and those complained of by the patient; (2) between the locations 
of these sensations; and (3) between the modifiers of these sensations. 
Thus, the pain of a headache may be described by one person as resembling 
that which would be caused by driving a nail through the head, by another 
as a constant throbbing. In the first case, the pain may be located in the 
side of the head; in the second, in the forehead. The pains of the first may 
be aggravated by the fumes of tobacco smoke, and relieved by lying on the 
painful side; the second may be aggravated by a bright light or by any 
sudden noise or jar. The first patient may be worse in the morning, the 
second, in the afternoon. What are called concomitants are also of im¬ 
portance. The first patient may be a nervous, hysterical woman; the 
second a plethoric person who is jovial and happy when well, but violent 
when sick. The former needs one remedy; the latter should receive an¬ 
other. One must not expect to find in a patient for whom a ghen drug 
would be the appropriate remedy, all the symptoms produced by that drug 
on healthy persons; it is enough if the symptoms presented by the patient 

are found among those produced by the drug. 

Homeopathy as a system of therapeutics is unmodified by the changing 
views of pathologists. The drugs that Hahnemann and his friends "proved” 





Honey 

Hot-Air Bath 


THE STANDARD FAMILY PHYSICIAN 


442 


should be as useful to-day in diseased conditions presenting symptoms 
similar to those in the provings, as they were when prescribed by Hahne¬ 
mann a century ago. This applies just as much to diseases attributed by 
modern pathology to microscopic germs, as it does to such simple dis¬ 
turbances as a cold or a headache. The actual effect of homeopathic rem¬ 
edies on these micro-organisms has not been determined; it is the belief of 
many homeopathic physicians that their remedies make their patients un¬ 
fertile hosts for the germs. Not every person exposed to an infectious dis¬ 
ease contracts it; germs have been found in perfectly healthy persons. The 
homeopathic practitioners claim that their remedies convert the suitable 
soil in which the germs are flourishing, into one in which the organisms 
can no longer thrive. This, however, is supposition only. 

In making tests of homeopathy only those preparations of the drug 
should be used that were administered to the pro vers; and they should 
be procured from first-class homeopathic pharmacies. Aconite is prepared 
differently under the rules of the United States Pharmacopoeia from what 
it is for homeopathic use. In homeopathic pharmacy the fresh green plants 
are used for making tinctures wherever possible. The Homeopathic Phar¬ 
macopoeia of the United States requires that an estimate be made of the 
amount of moisture contained in a plant, and that in making a tincture 
nine parts of alcohol be added to one portion by weight of the dry portion 
of the plant. Special rules are laid down for dealing with insoluble sub¬ 
stances. The “potencies,” “dilutions,” or “attenuations,” are made from 
the tincture of the crude drug according to both the decimal and the cen¬ 
tesimal scale. Aconite 3X means one part of aconite to 999 parts of the 
vehicle; and aconite 2c means one part of aconite to 9,999 parts of the 
vehicle. Certain rules are laid down for the making of these “potencies.” 

Experience has demonstrated that some substances which in their crude 

« 

state are perfectly inert, have a remarkable power to both produce symp¬ 
toms in the healthy and cure similar symptoms in the diseased when they 
are “potentized” according to the rules of the homeopathic pharmacopoeia. 
Dr. Roux of anti-diphtheritic serum fame, is said to have declared that the 
treatment of diseases by “vaccines” and “serums” was a form of home¬ 
opathy. Certain nosodes, or disease-products, have been “proved,” and 
are being used by many homeopathic physicians. Perhaps the most popu¬ 
lar of these is tuberculin. This, however, is not to be prescribed for every 
case of tuberculosis, but only for those showing symptoms similar to those 
found in the provings of tuberculin. And, again, tuberculin is successfully 
prescribed in many cases which exhibit no evidence of tuberculosis, but in 
which the symptoms of the patient correspond with those produced by the 
drug. 

HONEY (MEL).—A sweet substance excreted by the bee (Apis mellijica ), 
and deposited in the honey-comb. When fresh it is fluid, but on standing 





443 


THE STANDARD FAMILY PHYSICIAN 


Honey 

Hot-Air Bath 


it gradually crystallizes. It is white, yellowish, or brownish-yellow in color, 
and readily soluble in cold water. Honey has the same properties as sugar, 
but is more apt to affect the bowels. In medicine its chief use is as an 
addition to bitter gargles. 

HONEY AND BORAX.—A mixture of powdered borax (60 parts), 
glycerin (30 parts), and honey (480 parts). It is used in the thrush of 
infants, and in eruptive ulcers of the mouth, being painted on the sore parts 
with a tuft of cotton wrapped around a finger. 

HOPS.—See Humulus. 

HOT-AIR BATH.—A bath in which the body, or part of the body, is 
exposed to the action of hot air for the purpose of inducing perspiration. 
In the so-called “ Turkish bath” several connecting rooms are heated at 
varying temperatures, from 104° F. to 140° F., the bather remaining for 
some time in each room so that his body is gradually brought into profuse 
perspiration. The bather is then given a cold shower-bath and massage, 
whereupon he rests upon a couch, wrapped in blankets. This form of 
bath is very exhausting and should be indulged in only by strong individuals. 
The fact that the head of the bather is also exposed to the hot air is an ob¬ 
jectionable feature, which may cause disagreeable consequences. Per¬ 
sons suffering from disorders of the lungs, of the heart, or of the brain, 
spinal cord, or nerves, can not be cautioned too earnestly against taking 
these baths. Hot-air baths, however, are to be preferred to Steam- 
Baths (which see), because in the former the body is actually made to per¬ 
spire, whereas in the latter the steam is merely precipitated upon the skin 
of the bather. In the following shall be mentioned some forms of hot-air 
bath apparatus. 

In the box-bath a box similar to that shown under Steam-Bath is 
used, the air being heated by means of a closed steam-radiator from which 
the steam can not escape. The head of the bather is outside the box. The 
air may be heated from 120° to 140° F., but patients should be cautioned 
against too high temperatures. In most cases a temperature of 120° to 
130° F. will be sufficient to induce perspiration, if the precaution be taken 
to heat the box before the patient enters it. Attendants are often in the 
habit of heating the air in the box to a temperature of 140° F., or over, con¬ 
trary to the fact that they know better. It is true that the human body will 
submit to many things, and that the skin affords good protection, but a 
temperature of 130° F. is sufficient to change vital organs; and hot-air 
baths are, therefore, not devoid of danger. The duration of the hot-air 
bath should be from ten minutes to half an hour, and a cold compress to 
the head is useful while in the bath. The bath should be followed by a 
cold douche, or by a cold bath; or, if after-perspiration is required, the 
entire body should be wrapped in woolen blankets for from half an hour to 
one hour, and massaged. 







Household 

Hydrastis 


THE STANDARD FAMILY PHYSICIAN 


444 


Local hot-air baths may be administered to the different parts of the 
body, such as the chest, the abdomen, the shoulders, the hips, or the limbs. 
For this purpose special apparatus have been constructed, which consist 
of boxes made of wood or of water-proof canvas, the openings of which fit 
the body snugly. The air in such an apparatus is heated by a gas or 
alcohol lamp with a tin chimney, the upper end of which runs into the appa- 



Fig. 230. Hot-air bath for the shoulder. 


ratus (see Fig. 230). Local hot-air baths are used especially in joint- 
affections, gout, arthritis deformans, and rheumatism, and also in painful 
nervous affections. After the bath lukewarm sponging, cold douches, and 
massage are to be recommended. 

Special apparatus are made in which the air, by means of electrical 
appliances, may be heated to a very high temperature (200° F., or over). 
These apparatus, called electrotherms, are more or less successfully em¬ 
ployed in obstinate affections of the joints. They require the use of special 
contrivances to protect the skin from burns. 

HOUSEHOLD REMEDIES.—See Domestic Remedies. 

HOUSEMAID’S KNEE.—Name given to a condition characterized by a 
chronic swelling in front of the knee-joint. It is due to an inflammation of 
the membrane lining the synovial cavity of that joint (see p. 38), and a 
Consequent accumulation of fluid. The affection has derived its name from 
the circumstance that it chiefly arises from working in a kneeling posture. 
Rest and cold applications may reduce the swelling, which is often accom¬ 
panied with much pain; but in stubborn cases operative treatment may be 






















445 


THE STANDARD FAMILY PITVTSICIAN 


Household 

Hydrastis 


necessary. Similar swellings occurring generally on the wrist, are called 
ganglia. See Ganglion. 



HUMULUS (HOPS). The carefully dried strobiles of Humulus Lujm - 
lus, or hop-vine, a very widely distributed, climbing herb. Its most im¬ 
portant constituent is a yellowish, glandular powder termed lupulin, which 
contains volatile oils, terpenes, and a number of unknown constituents. 
The action of hops is diuretic and slightly sedative; and it is used internally 
as an antispasmodic. It has very little of its reputed value to cause sleep. 

HUNCHBACK. The development of a deformity in the back (Fig. 
231) affords indisputable evidence of the existence of an inflammation in 
the vertebral column, a destructive 
process in one or more vertebrae. 

In the majority of cases the con¬ 
dition is due to a tuberculous dis¬ 
ease of the backbone, a chronic 
process which it may take years to 
cure. In the course of the disease 
other serious symptoms may ap¬ 
pear, including paralysis of the 
legs, of the bladder, and of the in¬ 
testine. Suppuration may also set 
in, resulting in the formation of 
cold abscesses which may burrow 
their way into the pelvis or into 
the thigh. The treatment of this 
disease requires great care. Efforts 
to prevent further deformity de¬ 
mand rest on a hard, flat mattress; 
suspension in a special form of 
sling; the application of various 
apparatus or plaster corsets, etc. 

The cold abscesses usually disap¬ 
pear by a process of gradual ab¬ 
sorption; but if this does not take place they may be evacuated by incision 
or by aid of an aspirator, followed by the injection of various medicinal 
substances. 

HYDRARGYRUM.—See Mercury. 

HYDRASTIS.—The dried rhizome of Hydrastis Canadensis , a low herb 
growing in open woodlands in the eastern United States. It is known also 
as goldenseal, orangeroot, and turmeric-root. Its active principle is the 
alkaloid hydras tin, and the root also contains a small percentage of oil, 
berberin, and other inert substances. Hydrastin acts chiefly on the un¬ 
striped muscle-tissue in the body, and is therefore utilized to constrict the 


Fig. 231. Hunchback. 









Hydrocele 

Hypnotism 


THE STANDARD FAMILY PHYSICIAN 


446 


blood-vessels, to raise blood pressure, and also to affect the uterus. Fur¬ 
thermore, it is of value in the treatment of relaxed conditions of the hollow 
organs, particularly in some forms of diarrhea and in bladder disturbances. 
It is chiefly used in the form of the fluid extract, in doses of from ten drops 
to half a teaspoonful. 

HYDROCELE.—An accumulation of water between the testis and the 
surrounding layers. This condition may cause serious swellings, and is 
very trying to the patient. The disease may be either congenital or ac¬ 
quired. When acquired it frequently results from external injuries to the 
testicle, as from a knock or a blow. Congenital hydrocele in young chil¬ 
dren is easily removed by making an incision and draining off the water. 
In some cases this treatment must be repeated several times before a cure is 
effected. In adults an incision is not always sufficient in the treatment of 
hydrocele, as the water continues to gather. In such cases splitting of the 
tunics will prove effectual. This operation is absolutely without danger. 

HYDROCEPHALUS.—Dropsy of the brain; a condition characterized 
by a morbid accumulation of fluid between the membranes or within the 
ventricles of the brain. This disease is cither congenital, or it arises during 
the first years of life. The constantly growing pressure exerted by the 
water upon the brain and skull results in a wasting of the substance of the 
brain and in enlargement of the circumference of the skull. Children thus 
affected remain bodily and mentally undeveloped. They scarcely learn how 
to talk; they are affected by spasms and muscular twitchings; and most of 
them die during the first months or years of life. Attempts have been made 
to remove the fluid operatively, by puncture of the skull; but at best this 
operation has been attended with only temporary success. 

Dropsy of the brain must not be confused with that form of enlargement 
of the skull which occurs in rickets. The deformed, shaking head, with 
the small trunk, crippled limbs, and idiotic facial expression, so character¬ 
istic of patients suffering from dropsy of the brain, is absent in rickets. An 
illustration will be found under Imbecility (Fig. 235). Acute dropsy of 
the brain is another name for acute cerebrospinal meningitis. 

HYDROCHLORIC ACID.—A colorless, transparent, corrosive acid, com¬ 
mercially prepared by the action of sulfuric acid on common salt. When 
swallowed it causes abdominal spasms and excruciating pain in the stomach. 
The patient suffers great thirst, his skin is dry and burning, and the pulse 
small. The treatment consists in administering magnesia, soap, or some 
diluted alkaline solution. Mucilaginous drinks should be given freely. 

The diluted hydrochloric acid contains 100 parts of the stronger acid in 
219 of water. It is given in doses of from 15 to 30 drops in water, and is 
useful as a tonic in some febrile diseases, and as a digestant in gastro¬ 
intestinal disturbances. The strong acid is often used to remove warts and 
corns, but is less effective than Nitric Acid (which see). 





447 


THE STANDARD FAMILY PHYSICIAN 


Hydrocele 

Hypnotism 


HYDROPERICARDIUM.—See Pericarditis and Hydropericardium. 
HYDROPHOBIA.—See Rabies. 

HYDROTHERAPEUTICS.—See Water Treatment. 

HYMEN.—A thin membrane which closes the vaginal entrance, with 
the exception of an opening in the center large enough to allow the passage 
of a finger. It tears with bleeding during the first sexual intercourse, and 
is destroyed by the first childbed, nothing remaining but small, wart-like 
projections. It is of no great value as a sign of virginity, as it may have 
been torn accidentally during childhood; and, on the other hand, if the 
membrane is very extensible, it may be preserved until the first childbed, in 
which case it may occasionally become an obstruction to birth. 

The congenital closure of the hymen may be fraught with great danger 
if medical assistance be not called in time. In such cases the menstrual 
blood is dammed up at the time of puberty, causing severe abdominal 
pains, and dilating the vagina, the womb, and the tubes into large blood- 
tumors which finally tear and lead to death by peritonitis. In young girls 
who suffer every four weeks from continually increasing abdominal pains, 
but who do not menstruate, a medical examination is necessary. 

HYOSCYAMUS.—The dried leaves and flowering tops of Hyoscyamus 
niger , or henbane, a plant indigenous to central and southern Europe, and 
Asia, and sparingly cultivated in the United States. The leaves and seeds 
contain a number of closely related alkaloids, the most important of which 
are thought to be hyoscyamin, and hyoscin or scopolamin. The physiolog¬ 
ical action of hyoscyamus very closely resembles that of belladonna. It 
causes the mouth to become dry, and brings about a condition of more or 
less active excitement, leading to delirium, or in larger doses to coma and 
sleep. It diminishes the secretions; and like belladonna it increases the 
activity of the respiratory center, or in larger doses paralyzes it. The ac¬ 
tion of hyoscyamin differs somewhat from that of hyoscin in that the former 
causes more excitement, hyoscin often being used to produce sleep. Hy¬ 
oscyamus is a very active remedy, and should be prescribed only with great 
caution. 

HYPNOTISM.—A somnambulistic state in which the mind becomes 
abnormally impressible to suggestions. It is a well-known fact that the 
majority of human beings are influenced in their actions and opinions by 
other people. They acknowledge that reasons given by others are \alid, 
embrace their views, and accept and follow advice given them. Similar oc¬ 
currences are observed in medicine. A sick individual may be influenced 
favorably or unfavorably in regard to his affection. Even the physician s 
simple assurance, uttered convincingly, that the affection is not dangerous, 
that it is sure to be cured before long, and that the fears of the patient are 
unfounded, raise the courage and the hopefulness of the patient. Owing 
to the intimate connection between mind and body such encouragement 








Hypnotism 

Hypochondria 


THE STANDARD FAMILY PHYSICIAN 


448 


also stimulates the activity of the latter, so that morbid disturbances are 
more readily overcome. This influence of the physician has always been 
known, and has ever been utilized, consciously or unconsciously. Inten¬ 
tional “influence” has been developed lately as a special method, and the 
extent of its application limited. 

“Intimations” given to the patient for the purpose of ameliorating or 
curing his disease are often called “suggestions,” and the method of 
treatment founded upon this principle is called “suggestive treatment.” 
It is not always possible, however, to give a patient a curative suggestion 
while he is awake, or to render it effective; because while awake he may 
be too much under the influence of contrary ideas, contrary reasons, or 
auto-suggestions. To attain the desired end in such cases, the patient is 
therefore “made sleepy.” He is put into a condition resembling sleep, 
called hypnosis (from the Greek hypnos, “sleep”). During “artificial sleep” 
man is more susceptible to suggestions. 

It is possible to hypnotize the majority of people. Some even main¬ 
tain that all mentally sound persons are hypnotizable. It is obvious that 
some persons are more readily suggestible than others. The sleep, also, 
is more or less profound. Some persons become sleepy only to a slight 
degree, and are still able to offer resistance to the suggestions given; for 
instance, to open the eyelids although the hypnotizer orders them to do 
the contrary. Others fall into a light sleep and are unable, in accordance 
with the desire of the hypnotizer, to open the eyelids; they follow the “sug¬ 
gestions” entirely or in part. Still others fall into a profound sleep 
(somnambulism) which is distinguished by absolute submission to the com¬ 
mands of the hypnotizer, and by loss of memory; that is, upon awaken¬ 
ing, the patients do not know what happened to them during the hypnotic 
state. To accomplish a good result profound sleep is by no means always 
necessary; slighter degrees are very often fully sufficient. 

The production of the hypnotic state is accomplished in various ways. 
The best known method is that in which the subject is made to gaze upon 
an object, or to listen to monotonous sounds, such as the ticking of a watch. 
Another method consists in stroking the patient with the hands, either by 
touching a part of his body (for instance, the forehead) or by passing over 
it at some distance (“magnetic strokes”). In the latter method, however, 
which is employed by so-called magnetizers, no “magnetic power” is passed 
from the operator to the subject, as has often been assumed. Essentially 
the so-called magnetizing is nothing but hypnotizing. Physicians usually 
suggest the occurrence and the depth of sleep by words. It may be men¬ 
tioned, finally, that some persons are able to put themselves into a hypnotic 
state. This state, which is called auto-hypnosis, is undoubtedly the trance 
condition of spiritualistic mediums. 

Certain remarkable manifestations may be produced in hypnotized 








449 


THE STANDARD FAMILY PHYSICIAN 


Hypnotism 

Hypochondria 


persons. It is possible, for instance, to make certain parts of the skin, or 
even entire limbs, either insensitive or hypersensitive; to suggest loss of 
speech, sight, hearing, etc.; to make them drink water for wine; to put 
the body into a condition of general rigidity so that it becomes absolutely 
stiff, and to place the limbs in any desired position, even an uncomfortable 
one, and make them remain thus for some time (for instance, vertical rais¬ 
ing of the arm, see Fig. 232). During the somnambulistic state of the 
patient, it is even possible to give 
orders which he is to execute some 
time after awakening (post-hypnotic 
suggestions). 

In the small space which is here 
afforded a complete exposition of 
this field can not be made. It only 
remains, therefore, to state briefly 
in which cases hypnotism is suit¬ 
able for curative purposes. Nerv¬ 
ous affections of the most varied 
descriptions have been shown to be 
susceptible to hypnotic treatment; 
as, for instance, hysteria, involun¬ 
tary thoughts, conditions of fear, 
headache and migraine, disturb¬ 
ances of sleep, and nerve pains. 

1 

Sexual perversions and bad habits 
may also be beneficially influenced. 

Many troublesome symptoms of 
affections which are not of a nerv¬ 
ous nature may at least be amelio¬ 
rated to some extent. It is obvious 
that diseases which are otherwise 
incurable can not be influenced, for hypnotism is no miraculous remedy. 

Occasionally it happens that the hypnotic state is followed by conditions 
of indisposition; such as giddiness, headache, fatigue, trembling, or even by 
severe hysterical manifestations. It is to be borne in mind that no one can 
be hypnotized against his will. Resistance effectually prevents the phe¬ 
nomenon. Hypnotism is a condition depending upon voluntary submission 
to the will of another person; it is not a question of one’s being compelled 
by another’s will. 

HYPOCHONDRIA.—A condition of mental depression, in which the 
affected individual usually believes himself to be suffering from some severe 
disease, such as syphilis. While not actually amounting to insanity, it fre¬ 
quently develops into a condition which borders on the morbid. Moreover, 



Fig. 232. Rigidity of limbs brought about by 
hypnotism. 





















Hysteria 


THE STANDARD FAMILY PHYSICIAN 


450 


hypochondria may exist as a part symptom of some general mental disease, 
such as manic-depressive insanity. See Insanity. 

HYSTERIA.—A nervous affection characterized by functional dis¬ 
turbances. Hysteria was known to the physicians of ancient Greece, and 
many of the prophesying priestesses, who uttered their oracular sentences 
during paroxysms of emotion, were merely hysterical women. Hysteria 
was formerly believed to be due to some affection of the womb; hence its 
name, which is derived from the Greek hystera (“womb”). The malady 
was therefore considered to be a disease affecting only the female sex, es¬ 
pecially old maids. This erroneous opinion prevailed until the middle of 
the nineteenth century when it was definitely refuted, owing especially to 
the investigations conducted by the Paris school under the celebrated nerve- 
specialist Charcot. It is now known that hysteria has nothing to do with 
the womb, and that it occurs in males as well as in females, and in adults 
as well as in children. It is an affection of the brain, and is due to purely 
mental causes. 

During the middle ages, and even in more modern times, hysteria has 
been associated with superstitious beliefs in bewitchment and enchantment, 
and in being possessed by evil spirits. Hysteria found a fertile soil during 
a period characterized by religious fanaticism, ignorance, and supersti¬ 
tion. Pictures from that period have been preserved, depicting cures of 
such “possessed” persons. These pictures show the exact symptoms which 
to-day can be seen in hysterical patients in every clinic for nervous dis¬ 
eases. Fortunately, a change has taken place in the treatment. Torture 
and pyre, exorcism and conjuration, are no longer employed; but physicians 
treat and cure the malady by the application of water and massage, by 
regulating the diet, and by suggestion, etc. What formerly were described 
and wondered at as miraculous cures of possessed persons (having often 
been the cause of canonizations) are now revealed to science as the cure 
of hysteria by hypnotic suggestion. Such cures are now effected by nerve- 
specialists; and the methods employed are taught in the clinics. The 
belief in evil spirits that dwelt in human beings and rendered them “pos¬ 
sessed,” has died out; and modern enlightenment has made it clear that 
these people were merely diseased persons suffering from hysteria. 

The main underlying cause of hysteria is heredity, to which are added 
the exciting causes that bring on the manifestations of the disease. The 
affection may occur at all ages, most frequently between the tenth and the 
thirtieth years of life; not quite as often in men as in women. Some au¬ 
thors, however, report that, according to their statistics, the number of 
hysterical men is even larger than that of hysterical women. 

Among the occasional causes of hysteria mental excitement is the most 
conspicuous. A single emotion or shock may be sufficient to cause an attack 
of hysteria in persons who are hereditarily predisposed, and who are weak- 






451 


THE STANDARD FAMILY PHYSICIAN 


Hysteria 


ened by a faulty education, by religious expiations with fasting and casti¬ 
gation, by mental overwork, or by accident or injury. As a result of mental 
imitation epidemics of hysterical convulsions may be called forth in schools, 
convents, etc. In ancient times such epidemics were by no means infre¬ 
quent. The mental shock which accompanies an injury, or which occurs 
b) witnessing an accident, may occasionally lead to an outbreak of hysteria. 
Such a shock may cause sudden paralysis, or the individual may lose the 
faculty of speech. Mental and physical overexertions, sexual perversions, 
and excessive onanism may likewise give rise to hysteria. 

The different manifestations of hysteria, called stigmata ( lf signs”), 
depend upon the condition of each given case. The signs are physical as 
well as mental ones. The most important physical sign consists in a loss 
of sensitivity, or in a hypersensitivity, of the skin of the entire body, or of 
some parts thereof. This sign had been observed in the middle ages, at 
which time it was taken to be the mark of the devil; and the alleged witches 
and sorcerers were examined with regard to this phenomenon. If parts 
of the skin were found to be insensitive to the prick of a pin, the Church 
declared the unfortunates to be convicted of witchcraft and sorcery, and 
the hysterics were surrendered to the secular authorities to be burned on 
the pyre. Partial insensitiveness of the skin is very frequent in the hysteric, 
and may affect small spots or large areas, the skin of one limb or that of 
the entire half of the body. Mucous membranes (for instance, that of the 
mouth) are sometimes without sensation. The smallest blood-vessels of 
the skin (the capillaries) may be influenced reflexly, as it were; that is, by 
unconscious processes. These blood-vessels may become either spasmodic¬ 
ally narrowed to such an extent that pricks into the skin will not cause 
bleeding; or they may become so dilated in some places that blood escapes 
into the skin through their delicate walls. Disturbances of smell and taste 
may also occur. Especially remarkable are the disturbances of sight and 
hearing caused by hysteria. If increased sensitiveness to pain happen to 
occur in a joint, it may simulate a severe affection of the joint; and this 
condition becomes aggravated by rest and bandages, whereas it is much 
more apt to be cured if no notice be taken of it, and if the affected joint be 
used. 

Other frequent manifestations (such as muscular spasms and curva¬ 
tures of limbs) can be explained on the hypothesis of an excessive stimu¬ 
lation of certain nerve-fibers which are influenced in their activity by 
unconscious ideas. These phenomena happen in all muscles. If muscular 
spasms occur suddenly they give rise to distortions of the body. The 
patient tosses about wildly in morbid convulsions. Formerly this was ex¬ 
plained as “the possessed one being thrown to and fro by the evil spirit.” 
A frequent form of these harmless hysterical convulsions is the bridge posi¬ 
tion (see Fig. 233), in which the patient places his heels and the back of 





Hysteria 

Ice 


THE STANDARD FAMILY PHYSICIAN 


452 


his head firmly against the ground, while he stretches his body so that it 
forms an arch. The movements made during an attack of hysterical con¬ 
vulsions may be as varied and as clownish as those seen in a circus per¬ 
former. Generally they create a deep impression upon a layman, but they 
are without significance. Convulsive laughter, weeping, and screaming also 
belong in this category as being of hysterical origin. In some cases there 
occurs only a trembling of the muscles instead of well-developed convulsions; 
in the higher grades it may pass over into rhythmical beating, knocking, 
or trampling. If no attention be paid to these convulsive seizures, they 



cease spontaneously as a rule; but if the onlookers appear to become alarmed, 
the hysterical phenomena are apt to become aggravated. 

The muscles of the hysterics may be attacked by paralysis which may 
render one or more limbs useless. In such cases the patient may be obliged 
to use crutches or, if both legs be paralyzed, to remain in bed. In some 
instances the muscles of the larynx become paralyzed so that the patient is 
rendered unable to speak. The muscles of respiration and deglutition, 
however, are never involved. Hysterical paralysis may persist for years. 
As it is of purely mental origin, and not due to any demonstrable destruc¬ 
tions of nerves, the patient may always recover; and the paralysis may 
even disappear all of a sudden. If a paralyzed, hysterical patient be firmly 
convinced in his own mind that a certain remedy will help him, he will be 
cured by the application of that remedy. This is the “healing by virtue 
of belief” or, as physicians call it, suggestive effect. The form of the rem¬ 
edy is quite immaterial. It may be a conjuration or a threat with a red- 
hot iron, a prayer or a cold douche, a pilgrimage to a sacred shrine or the 
application of an electric current, the consulting of a quack or the firm ad¬ 
vice of a celebrated physician, the taking of an expensive medicine or of a 
silver-coated bread-pill. 

Any form of emotion may likewise act as a remedy. During a battle 
the hysterically mute son of a Persian king saw a hostile warrior approach 
his father with uplifted weapon. When he was on the point of striking 


















453 


THE STANDARD FAMILY PHYSICIAN 


Hysteria 

Ice 


the deadly blow the son suddenly exclaimed, “Man, thou art about to kill 
the king!” and thenceforth he was no longer mute. Every nerve-specialist 
and every laryngologist can relate examples of similar incidents that have 
occurred in the course of their own practise. 

The course of hysteria is usually a favorable one, it being of importance 
only that the physician diagnoses the disease correctly. This disease af¬ 
fords a striking proof of the absurdity of the contention of quacks, that a 
diagnosis is not necessary at all. A hysterical patient may possibly remain 
paralyzed all his lifetime if incorrectly treated; whereas it is possible that 
a physician who recognizes the affection may cure the disease in a few 
minutes. In severer cases of hysteria-it is advisable to isolate the patient 
in a suitable sanatorium for the treatment of nervous diseases. In such a 
place all modern remedies may be employed. But the principal point 
always remains the mental influence exerted by a physician familiar with 

the affection. Consult Dubois, The Psychic Treatment oj Nervous Disorders , 
New York, 1905. 


I 

ICE.—This is largely used to allay thirst in patients suffering from 
fever, and also as a hemostatic in pulmonary and gastric hemorrhages. In 
the latter class of cases it is better to apply it externally, in an ice-bag, than 
to administer it internally. The use of ice for cooling purposes, adminis¬ 
tered in ice-bags, cloths (for the throat), or ice-caps (for the head) is well 
known. Such cooling applications are of service in all inflammatory dis¬ 
eases which are characterized by local congestion, pain, and heat; espe¬ 
cially in meningitis, apoplexy, cerebral congestion, inflammations of the 
lungs, pleura, or pericardium, valvular diseases of the heart, gastric hem¬ 
orrhage, peritonitis, and in a number of other conditions, including recent 
contusions and sprains. In filling an ice-bag the ice should be broken up 
into small lumps by the aid of a fork or a nail; the ice-bag should be filled 
about half, care being taken to exclude all air from the bag before closing 
it, so that it will lie perfectly flat on the body. In order to avoid injuring the 
skin, a dry flannel or linen rag should always be placed under an ice-bag. 
Renewal of the ice is necessary in from one to two hours. 

In order to avoid undue pressure, the ice-bag may be suspended above 
the desired locality bv means of a contrivance similar to that shown under 
Peritonitis. It may be applied also over a cold compress; and in restless 
persons it must be held in place by a bandage. An “ice-pillow” may be 
prepared by mixing finely cracked ice with sawdust, or with ground flax¬ 
seed, and then enclosing the mass in a bag made from a piece of oiled silk. 
In this way the ice will last for a period of from three to four hours; and such 







Ichthyol 

Imbecility 


THE STANDARD FAMILY PHYSICIAN 


454 


a pillow is very grateful for the patient to rest his head upon. Ice used for 
internal administration should be strictly pure. 

ICHTHYOL.—A peculiar substance obtained in the form of a crude oil 
resulting from the destructive distillation of a shale-rock found for the most 
part in the Tyrolese mountains of Europe. The rock is made up largely of 
the fossils of fish; and in the distillation of the product the oil acquires a 
number of the decomposition products of these fish. Ichthyol is a very 
complex substance, and is of great use in the treatment of local affections, 
particularly erysipelas, wounds, and lupus, in a number of skin-diseases, 
and in some internal conditions. It is both antiseptic and stimulating. 
Its action is thought to be due in large measure to sulfur compounds. A 
number of artificial ichthyols have been manufactured, but are not by any 
means as effective as the natural product. 

ICHTHYOSIS.— See Fish-Skin Disease. 

IDIOCY. —See Imbecility. 

ILLUMINATION.— See Light. 

IMBECILITY.—A condition of severe mental defect. If of a grade 
severe enough to render the patient helpless, it is usually termed idiocy; if 
the patient is able to dress himself unaided, and to attend to the wants of 
nature, the affection is generally known as imbecility. The defect may be 
acquired or congenital. Acquired imbecility is usually a result of con¬ 
tinuous mental disturbances in early childhood. The form of mental 
defect due to affections of the brain, and to old age, is more properly termed 
dementia. Both imbecility and idiocy imply a defective development rather 
than a loss of brain-power once developed. The majority of idiots are the 
children of nervously or mentally deranged parents, the descendants of 
drunkards being especially liable to the affection. As in this instance an 
originally defective development of the mind will not allow of full mental 
growth, so may early affections of the brain (inflammations, or injuries) 
also result in like consequences. The greatest number of cases of imbe¬ 
cility results from injuries to the brain at birth, forceps operations being 
responsible for many. Children suffering from rickets are often mentally 
backward. 

A special form of idiocy is cretinism which is due to an affection of the 
thyroid gland (see Thyroid Gland, Diseases of). Cretins are lagging 
also in bodily development (see Fig. 234), and many of the dwarfs exhibited 
in circuses and museums owe their short statures to cretinism. The occur¬ 
rence of this disease is fortunately restricted to certain regions; for instance, 
to certain valleys in the Alps, and to a few places in the Palatinate and in 
Franconia. The cause of the degeneration of the thyroid gland is not 
sufficiently understood as yet. Not only cretins, however, but many other 
idiots are affected by disturbances of growth. Especially frequent are 
abnormalities of the skull, such as extreme smallness ( microcephalia ) or 





455 


THE STANDARD FAMILY PHYSICIAN 


Ichthyol 

Imbecility 



abnormal largeness ( macrocephalia; see Figs. 235, 236). Often the growth 
of the various parts of the body does not progress uniformly. Various de¬ 
formities are of frequent occurrence, such as crooked limbs, deformed feet, 
displaced teeth, harelip, cleft palate, and various other malformations. Other 
peculiarities often encountered in idiots are: epileptiform spasms, trembling, 
St. Vitus’s dance, paralysis, stuttering, and deaf-mutism, as well as a great 
variety of automatic movements, such 
as shakings of the head, peculiar 
movements of the lips, and grinding 
of the teeth. 

The mind may be stunted only, 
or there may be complete absence of 
mental independence. Every con¬ 
ceivable gradation may be encoun¬ 
tered. In idiots of the lowest grade 
the entire mentality is a barren field; 
they have absolutely no will-power; 
their facial expression is dull and 
silly; and the faculty of speech is 
absent. An idiot ranging slightly 
higher may show more mental and 
bodily activity, but his power of im¬ 
agination remains blunted and is re¬ 
stricted to the most simple concep¬ 
tions. His speech is clumsy, and his 
volition scarcely passes beyond per¬ 
ceptive impulses. The wide-spread 
opinion regarding the strong develop¬ 
ment of sexual desire in idiots, is 
erroneous. Sexual outrages, which 
occur occasionally, may be explained 
simply by the lack of resistance with 
which an idiot will follow his impulse. 

The milder grades of imbecility Fig 234 Cretin . 

approach the normal condition of the 

mind by gradual steps; and as a rule it is impossible to demarcate precisely 
the line dividing the normal from the abnormal state. Mental weakness is 
characterized, above all, by a superficiality of thinking, by the absence of 
the power of judgment, and by inability to deliberate carefully. Here, too, 
impulse is followed immediately by action, without the patient weighing the 
motives. Almost all imbeciles are extremely impulsive. Sometimes there 
is a strange inequality in the development of the mind; for instance, a phe¬ 
nomenal memory may exist together with an almost entirely undeveloped 























Imbecility 

Immunity 


THE STANDARD FAMILY PHYSICIAN 


456 


faculty of judgment. Many “lightning calculators” who appear in public, 
and are greatly admired, are unmistakably imbecile. 

The moral dulness of imbecile individuals is a characteristic phenomenon 
which manifests itself more frequently in the milder than in the severer 
forms of imbecility, often making it very difficult to have anything to do 
with these patients. From their earliest childhood these imbeciles are a 
burden to their parents and a torment to their teachers. Addicted to lying, 
cruel to animals, deceitful, and impulsively passionate, they defy all educa¬ 
tional efforts. They are incapable of attending to an occupation, owing to 
their lack of steadiness and perseverance, and to their mental superficiality, 



although they may learn to repeat some high-sounding phrases which may 
impress the uninitiated. They take up one trade after another, but fail in 
all. Owing to their unbounded egotism and to their lack of power to resist 
the temptations of life, they frequently collide with the laws. Neither the 
most careful education during childhood, nor any disciplinary punishment 
which may be administered later in life, is able to improve the abnormal 
character of these patients. Many of them end their days in the workhouse 
or in jail, unless they are placed in an insane asylum. It is often very diffi¬ 
cult to pass an opinion as to the mental condition of such individuals, as it 
can not always be determined whether or not they have passed beyond the 
limit of what is morbid. Some alienists designate these imbeciles as “mor¬ 
ally weak-minded,” an expression which should be used only with the 
greatest caution, as it is apt to produce the entirely erroneous opinion that 
alienists look upon immorality as a morbid condition. 
























457 


THE STANDARD FAMILY PHYSICIAN 


Imbecility 

Immunity 


Idiocy is incurable, although not always impossible of improvement. 
If it is due to rickets, medical treatment will often accomplish good results. 
The same holds good for cretinism, a successful method of combating affec¬ 
tions of the thyroid gland having been discovered recently. Even in cases in 
which the evil can not be attacked at the root, it is possible at least to make 
an attempt at mental development. Parents should not entrust their defec¬ 
tive children to an insane asylum. They should by all means consult an 
experienced physician and teacher who has made a specialty of this work. 
Extensive efforts have been made to instruct mentally weak pupils in sepa¬ 
rate “auxiliary schools.” Unfortunately, the problem of educating imbe¬ 
ciles, especially with regard to moral defects, is still unsolved. Neither 
insane asylums nor prisons nor workhouses are the right places for these 
unfortunates whom nature has neglected. They need special institutions, 
patterned somewhat after the Craig Colony for Epileptics in Sonyea, New 
York; the New Jersey State School for Feeble-Minded, etc. 

IMMUNITY.—Resistance to the poisons of infectious diseases, or to the 
bacteria which produce these poisons. It is a fact within the observation of 
every one, that some persons are much more apt than others to contract 
infectious diseases; and this variation in susceptibility may be noticed also 
among the lower animals, and even among plants. For instance, certain 
plants are found growing in soils which contain enough metallic poisons to 
destroy animal life; and some poisons which prove fatal to human beings 
are comparatively harmless to certain lower animals, as in the case of 
strychnin, to which birds are almost immune. The diseases to which plants 
are subject are practically never found among animals; nor are those which 
attack animals found among plants. Diseases of the human race are rare 
among the lower animals; and the various species of these animals differ 
with regard to the nature of the diseases to which they are prone. Thus it 
is seen that human beings, the lower animals, and plants respectively possess 
relative immunities to certain disease-producing agencies. 

These natural immunities may be lessened; as, for instance, when an 
attack of measles renders one more susceptible to the infection of tuber¬ 
culosis. On the other hand, a partial immunity may be strengthened, or 
even a new immunity acquired. Thus a distinction is made between natural 
immunity and acquired immunity; but in the light of the doctrine of evolu¬ 
tion, natural immunity may be considered as one acquired by heredity. 
Immunity in human beings includes both natural and acquired poweis 
which the body possesses to destroy bacteria (bacteriolytic power), and to 
destroy poisons (antitoxic power). The struggle between these forces and 
the bacteria and toxins which they combat, is a most interesting field of 
investigation, and one which still offers mysteries to be solved. 

The practical utilization of acquired immunity began with the intro¬ 
duction of vaccination, which was arrived at from observations of the immu- 





Impotence 


THE STANDARD FAMILY PHYSICIAN 


458 


nity which followed an attack of measles, scarlet fever, or smallpox. Other 
diseases, such as influenza and erysipelas, also confer an immunity, but a 
more transient one. An animal may acquire for itself an active immunity 
by direct adaptation; or it may have conferred upon it a passive immunity 
by a body made in the blood-serum of another animal. Just how this im¬ 
munity is brought about is not positively kncfwn, and several theories attempt¬ 
ing to account for it have already been exploded by investigation. According 
to Pasteur’s “exhaustion theory,” the bacteria died when the available food 
supply was exhausted; and the “retention theory” assumed that they died 
from their own products. Both these theories have been proved untenable. 
Other theories—the “mechanical,” the “humoral,” and the “phagocytal”— 
contain modicums of truth, but fail to cover the whole ground. At present, 
the theories which gain most credence are chemical, and the most conspicuous 
is Ehrlich’s “side-chain theory.” This is a very elaborate and technical 
theory; but the principle on which it is based, that the blood-serum of men 
and animals may be so modified that it can overcome the effects of bacteria 
and toxins, is one which has borne practical fruit in the production of the 
now indispensable diphtheria antitoxin. With this successful production of 
a passive immunity in man, it was hoped that a means had been found to 
overcome all the infectious diseases; but this hope was doomed to disap¬ 
pointment, as it was soon discovered that other diseases necessitated reckon¬ 
ing with more unmanageable factors than the simple toxins. The poisons 
as well as the bacteria must be destroyed; that is, antitoxic as well as bac¬ 
teriolytic immunity must be secured. According to Ehrlich’s theory, the 
cell-body possesses a number of side-chains or receptors which can combine 
with food-products for the metabolism of the cell. Some of these can com¬ 
bine with toxic products as well, with damage to the cell. Ehrlich believes 
that antitoxins consist of surplus receptors made by the cell, and thrown off 
in the blood-serum. Here they unite with the toxin, and thus permit the 
receptors of the cell to perform their normal food-taking function. In 
regard to bacteriolytic immunity, it is found that the blood-serum of certain 
animals, injected into an animal of another species, occasions the destruc¬ 
tion of the red blood-cells of the latter. Blood-serum may by artificial means 
be made to exert a similar action upon certain bacteria, thus conferring a 
bacteriolytic immunity. 

As Prudden has pointed out, “there seems to be abundant ground for 
the belief that the protective agencies which are evoked in both natural and 
artificial immunization, are simply those which the body makes use of in its 
normal metabolism, exaggerated and diverted to different ends, it is true, in 
the face of emergencies.” 

IMPOTENCE.—A condition due to morbid disturbances in the sexual 
organs of man, rendering him unable to beget children. Distinction must 
be made between the inability to perform coition and the inability to fecun- 






459 


THE STANDARD FAMILY PHYSICIAN 


Impotence 


date. The former condition, which constitutes impotence in the true 
acceptation of the word, may be absolute or conditional. In sterility, 
although coition may be possible, there is either a complete absence of 
semen, or the seminal fluid does not contain the spermatozoa necessary to 
fecundation. The latter condition is due, as a rule, to morbid processes 
which have led to an obstruction of the seminiferous canals; as, for instance, 
gonorrhea. 

Impotence in the narrower sense, in which the performance of coition is 
prevented or impeded, may be due to congenital or acquired deformities of 
the male organ of sex, many of which may be removed bv operative means. 
Severe constitutional diseases (such as diabetes mellitus, inflammation of 
the kidneys, and morphinism) may decrease or entirely suspend the ability 
to perform coition. These forms of impotence are generally incurable, as 
the original disease can rarely be treated effectually. More amenable to 
treatment are the more frequent cases of so-called “nervous impotence.” 
In this form, although sufficiently strong erections may be present at inop¬ 
portune times, as well as pollutions at night, the erections are either entirely 
absent, or incomplete, at the very moment when sexual intercourse is in¬ 
tended. In other cases nervous impotence manifests itself by an irritable 
weakness in which a discharge of semen takes place before, or during, the 
introduction of the male organ into the vagina, or even upon the slightest 
sexual excitement. The rigidity of the organ then relaxes very soon after 
the emission of the semen, and the performance of coition becomes impos¬ 
sible. These forms of nervous impotence may be due either to masturba¬ 
tion, to irritative conditions, or to obstinate gonorrheas; they are rarely due 
to excessive sexual intercourse, and still more rarely to neurasthenia. 

Conditions of nervous impotence are amenable to medical treatment, 
although success can not be promised in every case. Treatment must be 
undertaken only by a physician, as the prospect of recovery depends to a 
great extent upon the possibility of discovering the causative conditions; 
and the discovery and removal of the causes are exclusively the concern of 
a trained physician. Patients suffering from nervous impotence or from 
frequent emissions should pay no attention to the many advertising quacks 
who prey upon their minds and their pockets by their misleading liteiatuie. 
The depression of mind that results from this disorder forms a feitile soil 
for these quacks and charlatans. By their so-called infallible remedies 
and methods, and with a shameless utilization of advertisements in the daily 
press, these persons know how to extort the last penny from their victims. 
As a general rule it may be stated that an appropriate psychic tieatment 
by a competent practitioner, combined with a carefully regulated diet as 
well as with physical treatment by water, electricity, and massage, is able to 
accomplish much more towards curing nervous impotence, and the neuras¬ 
thenia which frequently accompanies this condition, than can be accom- 








Incubation 

Infection 


THE STANDARD FAMILY PHYSICIAN 


460 


plished by a treatment with drugs, although the latter can not be fully 
dispensed with in every instance. In all cases of nervous impotence it is 
necessary to observe a certain abstinence from sexual intercourse, and above 
all to avoid sexual overexcitement. The so-called “occupation impotence,” 
in which a diminution or suspension of the sexual functions is called forth 
by bodily or mental overexertion, is merely a temporary affection. 

Congenital absence of seminal fluid can not be cured, whereas lack of 
semen due either to phimosis (see Foreskin, Diseases of) or to narrowing 
of the urethra, can be cured by operation and by local applications. Tem¬ 
porarily occurring deficiency of semen is somewhat related to nervous 
impotence, and may be cured by similar methods of treatment (see above). 

Inability to fecundate, in the presence of ability to perform coition, is by 
no means as rare a condition as is generally assumed. It has been stated 
by Furbringer that in 35 per cent, of all childless marriages the fault is in 
the husband; and that in 30 per cent, it is due to the absence of sperma¬ 
tozoa from the seminal fluid. Apart from other affections of the testicles 
(tuberculosis, cancer, syphilis, contusion, etc.), gonorrheal epididymitis of 
both sides is an important factor in causing this condition. 

With regard to treatment it is impossible to give any general rules. 
Wasting of the testicles having once begun, a restoration of the seminal 
secretion is out of the question. All depends upon the cause in each indi¬ 
vidual case, and how to determine this must be left to a skilled physician. In 
recent inflammations due to injury, and in syphilitic affections of the testi¬ 
cles, a cure may be expected. Tuberculous affections of the testicle and 
epididymis of both sides, as well as bilateral gonorrheal epididymitis, do not 
offer much prospect of recovery. The former disease usually necessitates 
complete removal of the affected organs, and in the latter malady it is possi¬ 
ble only in exceptional cases to reopen the collapsed seminal canals. It 
follows that nothing can be expected from a cut and dried treatment of the 
various forms of impotence, and that there can be no infallible remedies for 
this disorder because of the many causes underlying it. Treatment must be 
directed to the causative affections; and only a physician is able to deter¬ 
mine the conditions of each individual case, and to take the responsibility of 
prognosis and treatment accordingly. 

INCONTINENCE OF URINE.—See Enuresis. 

INCUBATION PERIODS.—Between the time of exposure to infection and 
the actual appearance of the first symptoms of disease, there usually inter¬ 
venes a longer or shorter period, which is called the period of incubation 
(or hatching). In some contagious diseases the length of this period is a 
definite characteristic of the affection; in others, it may vary considerably. 
Asiatic cholera , for instance, may require an incubation period of five days; 
or it may develop about twelve hours after the entrance of the micro-organ¬ 
ism. Diphtheria develops in from two to seven days; German measles in 




461 


THE STANDARD FAMILY PHYSICIAN 


Incubation 

Infection 


from fourteen days to three weeks; gonorrhea in about twenty-four hours; 
influenza in two or three days; measles in about fourteen days; rabies 
(hydrophobia) in between three and eight weeks, sometimes considerably 
later, scarlatina in a day or two; typhoid fever in about two weeks. 

Whenever a person knows that he has been exposed to contagion, he 
ought to pay particular attention to any symptoms, however insignificant, 
that may appear during the maximum period of incubation. In the case of 
children who have been thus exposed, they ought to be kept from school 
until all likelihood of their having become infected has disappeared. It is 
always the safest method to wait some days beyond the normal maximum 
periods. For more extensive information, the various articles on contagious 
diseases must be consulted. 

INDIAN HEMP.—See Cannabis Indica. 

INFANT, CARE OF.—See Nursling, Care of. 

INFANTILE PARALYSIS.—See Paralysis. 

INFECTION.—The exciting causes of contagious diseases are either 
transmitted directly by the patient, his immediate surroundings, or his 
excreta; or they are distributed over large areas by the medium of the air. 
Infection through the air is possible with the readily transportable germs of 
influenza, measles, smallpox, scarlet fever, whooping-cough, mumps, etc. 
Where the germs are communicated directly from one individual to another 
(as in typhoid fever, diphtheria, cholera, tuberculosis, hydrophobia, venereal 
diseases, etc.), the contagion occurs through the medium of the clothes or 
various personal utensils, or through insufficient cleansing of the hands be¬ 
fore eating, especially when they have been in contact with the sick person 
or with anything belonging to him. Infection may result also from the 
ingestion of food materials containing disease-germs, especially water and 
raw milk; from bathing in streams which are contaminated by the drainage 
from infected localities; or from using unclean water for washing eating- 
utensils. Bacteria may be transmitted also by insects, particularly through 
their stings (malaria; yellow fever), or by their contaminating food or open 
wounds after having been in contact with infectious materials; typhoid, for 
instance, is often transmitted in this manner by flies. 

The spread of contagious diseases is furthered by lax health-laws, by 
incorrect methods of living, by inadequate drainage, by lack of pure and 
wholesome drinking-water, by damp and overcrowded dwellings which lack a 
sufficient amount of light and air, by insufficient attention to the cleanliness 
of the body and surroundings, and by neglected or incomplete isolation of 
patients suffering from contagious diseases. The risk of infection is in¬ 
creased also by the mode of living necessitated by certain callings, and by 
the diminished resistance of the body resulting from such occupations. 
Other exciting factors are: severe exertions, sudden changes in temperature, 
prolonged detention in dry, hot or cold air, working in the water, the devel- 







Infection 

Inflammation 


THE STANDARD FAMILY PHYSICIAN 


462 


opment of dangerous gases or moisture, abuse of alcohol or other toxic sub¬ 
stances, etc., etc. 

Measures for preventing contagious diseases, or their spread in any given 
case, had best be prescribed by a physician who is familiar with the subject 
and its dangerous aspects. It is essential, therefore, to summon medical 
aid at once in every suspicious case, so that the patient may be placed under 
appropriate treatment, and further evil consequences avoided. In cases 
where disease has been transmitted through the air, the patient should at 
once be isolated and, if necessary, placed in a hospital. If the patient be a 
member of a large family, the remaining members, as well as the servants, 
should not be permitted to come in contact with the patient’s nurse, nor to 
have any communication with her, as many diseases, such as scarlet fever 
and smallpox, may be readily transmitted through an intermediary. Nurses 
must observe extreme cleanliness of their persons. They should rinse the 
mouth frequently, bathe the entire body every day, change their under¬ 
clothing oftener than usual, and wear protective gowns made from washable 
material. Above all, they must not take their meals in the sick-room. The 
disinfection of the patient’s excreta, clothing, and utensils is fully treated in 
the article on Disinfection. The sick-room should always be well aired; 
it should be thoroughly disinfected after the illness and, if possible, not occu¬ 
pied until several weeks later. 

During the prevalence of an epidemic the appearance of bronchial, gas¬ 
tric, or intestinal catarrhs should be given special attention, because the 
inflammatory condition present in these cases greatly favors the entrance of 
germs and their transmission through the body. All overindulgence in eat¬ 
ing and drinking must be strictly avoided, and a perfectly normal mode of 
living insisted upon. 

Particular attention should be directed to the possibilities of the spread 
of contagion among certain classes of workmen who handle materials which 
may contain disease-germs; such as hat-makers, paper-makers, and rag- 
sorters (see Anthrax). The inhalation of dust (whether from metal, coal, 
stone, flour, or tobacco, etc.) produces a permanent irritation of the lungs 
and air-passages, which predisposes to the development of pneumonia, 
tuberculosis, influenza, and other pulmonary diseases, because the resistance 
of the lung-tissue becomes lowered. 

In addition to the ordinary precautions, energetic disinfection of the 
stools and of the dirty linen is usually sufficient to prevent the spread of 
typhoid, cholera, and dysentery. During the prevalence of an infectious 
disease the water used for drinking and washing should be thoroughly 
boiled, as should also the milk. As it is well known that small wounds of 
the skin and of the mucous membranes permit the entrance of infectious 
agents (causing erysipelas, septemia, etc.) such wounds should be treated 
with the greatest care. Of untold value is the protective vaccination against 



463 


THE STANDARD FAMILY PHYSICIAN 


Infection 

Inflammation 


smallpox, the omission of which must be looked upon as a crime. The 
early injection of Behring’s serum in diphtheria, and the timely treatment 
of rabies are also important. 

A person suffering from a contagious venereal disease should not be led, 
by a sense of false shame, to hide its existence, or to seek the aid of a char¬ 
latan in its treatment. In this instance nothing but the timely services of a 
physician are able to overcome an evil which not only endangers the life of 
the individual, but which may involve also the entire family. As a rule, 
contagious diseases are most effectively combated by the destruction of their 
specific germs, by personal cleanliness, by sanitary dwellings, and also by 
increasing and maintaining the natural resistance of the body by appropri¬ 
ate measures already treated under the caption Hardening. Two other 
factors, which aid a person in warding off disease, are fearlessness and an 
energetic will—two qualities which, in addition to other precautions, assist 
the physician in protecting his own person against infection. 

The best way to treat infectious diseases is to prevent them. It is not 
necessary for children to have them at all. Social conditions may make it 
difficult for parents to prevent the many possible accidental contaminations, 
but if all parents were properly informed, and conscientious in their duties 
to others, much avoidable sickness would be prevented. The father or 
mother who permits a child recovering from an infectious disease to go to 
school before the period of possible contagiousness is past, is a true crimi¬ 
nal, either through ignorance or intent. What does a week’s loss in school 
amount to in comparison with the hundreds of sick and dying children that 
may come to such condition from one sick child who returns to school 
while convalescing? Parents should be more careful; and to curb the care¬ 
less ones they should support the efforts of enlightened boards of health 
who demand that medical school-inspectors examine ailing children for 
possible infectious diseases. Every community, no matter how small, 
should have its health officer. He is a much more important township 
official than a road-surveyor. The former can save the lives of those who 
grow up to be men and women; the latter saves the wagons and the horses 
a little, and gains time in hauling truck. Which is the more important? But, 
should an infectious disease be caught, it should be carefully treated. Not one 
is to be treated carelessly, no matter how mild the patient’s symptoms may be. 

INFLAMMATION.— The human body is subjected to numerous external 
injuries of varying degrees, which may cause disturbances in its normal 
functions. The system is constantly engaged in limiting the effects of such 
injuries and in restoring the natural conditions; that is to say, in bringing 
about a cure. One of the processes which takes place in the body as a 
result of such injury is known by the term “inflammation.” This process, 
which is concerned with eliminating the effects of the injury, tends to run a 
definite and characteristic course. 






Influenza 

Inhalations 


THE STANDARD FAMILY PHYSICIAN 


464 


Among the various causes of inflammation may be mentioned blows, 
burns, irritations, and cold; but especially the penetration of toxic bacteria. 
The body responds to the influence of the injury by sending an increased 
flow of blood to the part. As a result of this increased supply of blood the 
vicinity of the injured area swells, and becomes tender and painful; the 
skin reddens, and a sense of local heat is present; in other words, an inflam¬ 
mation has been produced. Inflammations due to toxic bacteria are the 
most frequent, and also the most dangerous, because these germs multiply 
in the body, and the process may spread to such an extent that death results. 
Inflammation really expresses the effort of the organism to overcome the 
cause of the trouble; thus, in case of a bacterial invasion the intention is to 
destroy the bacteria. Inflammation usually results in the formation of pus 0 
If formed in small quantities this pus may be absorbed by the system; but 
where larger quantities collect it results in the formation of abscesses. 

Two types of inflammation are recognized: the acute form which runs 
a very rapid course; and the chronic form which runs a more protracted 
course. To the former type belong all the painful inflammations marked 
by local redness and swelling, and accompanied by fever; whereas the prin¬ 
cipal example of the latter form is the tuberculous inflammation. Medical 
treatment aims to support the system as the inflammation runs its course, 
and thus to favor healing. Whenever it is possible to do so, the cause must 
be removed, whereupon the body, and particularly the affected part, requires 
complete rest and protection. Nutrition should be stimulated by the ad¬ 
ministration of an easily digestible, bland diet. Special remedial measures 
are indicated according to the variety of the inflammation, and the organ 
involved; but all these must be prescribed by the physician in every given 
case. 

INFLUENZA (GRIPPE). —An epidemic, infectious disease which is 
caused by the influenza-bacillus. It develops rapidly with a general feeling 
of indisposition, headache, pains in the limbs, chilliness, nasal catarrh and 
cough, and with the formation of herpes (fever-sores) on the lips and face. 
Influenza either restricts itself to these manifestations and disappears as 
rapidly as it came, or it progresses and affects in a more marked degree the 
respiratory passages, the digestive organs, and the nervous system. 

An involvement of the respiratory passages is always accompanied with 
marked nasal catarrh and frontal headache, and with inflammation of the 
mucous membranes of the eyes, mouth, pharynx, and bronchi. A tormenting 
cough sets in, the sputum being at first clear and viscid, later becoming 
purulent. The patient complains of pains in the chest and of difficulty in 
breathing. More or less marked fever and acceleration of the pulse are 
present at the same time. If the stomach and intestines are affected, there 
will be nausea, vomiting, spasmodic pains in the abdomen, and severe, 
sometimes bloody, diarrhea. Implication of the nervous system results in 





465 


THE STANDARD FAMILY PHYSICIAN 


Influenza 

Inhalations 


pains in the head, in the small of the back, and in the limbs and joints; 
conditions of excitement, delirium, and insomnia may be present, or there 
may be unnatural drowsiness. In some instances also the heart may be 
involved, this complication being manifested by palpitation, pains in the 
region of the heart, and cardiac weakness. 

The course of influenza, which usually averages about a week, may 
sometimes be protracted for weeks or months, owing to the frequent super¬ 
vention of other diseases. The complications most to be dreaded are 
pneumonia and pleurisy, and the rapid development of hidden or beginning 
tuberculosis. Other affections that may occur subsequently, are: inflam¬ 
mations of the nerves, paralyse^, spasmodic symptoms, affections of the 
heart, diseases of the eyes or ears, chronic catarrhs of the stomach and 
intestine, and irritation and inflammation of the kidneys. 

The prevention of this epidemic disease is scarcely possible. During the 
attack it is necessary that the patient remain in bed, with cold compresses 
(which become warm) on the chest; the diet should be restricted and, if 
possible, it should consist of milk only. In many cases it will prove bene¬ 
ficial to induce perspiration by giving the patient hot tea and hot lemonade. 
The greatest care is necessary during convalescence, as too early rising, 
errors in diet, or renewed colds are very liable to further the development of 
the complications mentioned. 

There are a number of acute febrile affections which occur, especially 
during infancy and childhood, in consequence of colds, etc. These affec¬ 
tions, which set in with chills, fever, depression, loss of appetite, headache, 
pains in the small of the back, and with the formation of blister-like erup¬ 
tions on the lips and in the face, last one or more days, and the symptoms 
may be more or less pronounced. The fever soon recedes, however, usually 
with the appearance of perspiration, and complete recovery soon takes 
place. In children these affections are mostly due to digestive disturbances; 
and- a restricted diet and a mild laxative are usually enough to bring about 
relief. 

INFUSIONS.—These are watery extracts of vegetable substances which 
are not quite soluble in water. The usual mode of preparation is to pour 
boiling water on the drug, and then to macerate it in a closed \cssol until 
the water has become cool. Infusions may be prepaicd also by percolation 
with cold water, but in this case the substance should be finely divided. 
The strength of an infusion varies, not only with regard to the drug pre¬ 
scribed, but also according to individual cases. 

INGROWING NAILS.—See Nails, Ingrowing. 

INGUINAL GLANDS, SWELLING OF.—See Bubo. 

INGUINAL RUPTURE.—See Rupture. 

INHALATIONS.—These may consist of cold or warm air, with which 
may be incorporated various volatile substances; or of cold or warm vapors 






Insane Asylum 


THE STANDARD FAMILY PHYSICIAN 


460 


containing salts or other medicinal remedies, finely divided powders are 
also sometimes used for inhalation. 

For the purpose of inhaling pure, fresh air, a change of climate may 
often be necessary; and if warm, moist air is desired, inland seas surrounded 
by woods, or southern resorts protected from high winds, should be chosen. 
Various forms of apparatus have been devised for supplying moist or medi¬ 
cated air for inhalation; and special atomizers are used for impregnating 
air with medicinal substances. Solutions of salts, tannic acid, pine-needle 
oil, turpentine, menthol, etc., are often used in these atomizers. A more 
complicated method of administering medicated inhalations consists in 
filling a whole room with the needed vapors, which are supplied by special 



Fig. 237. Government Hospital for Insane, Washington, D. C. (Administration Group). 


apparatus. For the inhalation of steam, an ordinary tall pitcher filled with 
boiling water may be used. 

INSANE ASYLUM.—An institution for the care of mentally deranged 
persons. Such an asylum answers a tw r ofold purpose. It is intended as a 
hospital where demented people may receive careful medical treatment 
with a view to curing them; or, if this be no longer possible, it serves them 
as a home in which they may receive all necessary care. Hence, insane 
asylums are hospitals in the true acceptation of the word, and it is very much 
to be regretted that the public still looks upon them as some kind of prison 
to wdiich a patient is to be transferred only when there is absolutely no other 
help. This view, which possibly may have been justified in times long past, 
is not correct at the present day. In keeping with the progress made in the 
recognition and treatment of mental diseases, the insane asylums of the 
present day have also acquired an entirely different appearance, in their ex¬ 
terior as well as in their interior. 

A large modern institution resembles a group of friendly villas (see Fig. 
2 37) without enclosing w r alls and latticed windows; and the interior, w r ith its 










467 


THE STANDARD FAMILY PHYSICIAN Insane Asylum 


pictures, mirrors, flowers, etc., differs but little from a cleanly and comfort¬ 
ably appointed private residence (see Fig. 238). Even where the peculiar 
character of the mental disturbances renders it necessary to take such pre¬ 
cautionary measures as the barring of windows and doors, these grates are 
so carefully arranged as to be scarcely noticeable. The wards for quiet 
patients often remain unlocked. Mechanical coercive measures (strait- 
jacket, etc.) have disappeared; rubber cells do not exist; and padded cells 
have become a curiosity. Isolating a patient in a “cell” is avoided as much 
as possible; in many places it is altogether forbidden. The former modes 



Fig. 238. Interior of a TVard. in the Government Hospital for Insane, W ashington, D. C. 


of treatment have been displaced by modern and enlightened methods. 
Any one who for the first time enters the reception room of an insane asylum 
will believe himself to be in an ordinary hospital. Patients whose condition 
will at all permit it are employed in the house or in the yard, in the work¬ 
rooms, or in the garden. Large institutions are usually connected with ex¬ 
tensive agricultural establishments. Simple pleasuics, such as cxcuisions, 
theatrical performances, and dances, are also provided for. 

The fear that a patient’s condition might become aggravated by inter¬ 
course with other demented persons has been disproved a thousand times 
by practical experience. The patient is usually sufficiently occupied with 


















Insanity 


THE STANDARD FAMILY PHYSICIAN 


4(i8 


himself, and he does not show great interest in his roommates. The well- 
regulated life in the institution, the trained nursing, and last, but not least, 
the removal from the conditions which caused his affection, act beneficially 
upon the patient, and are the most important conditions for his recovery. 

INSANITY.—It is important in the first place to realize that there is no 
single disease which may be called insanity. The word, as such, is more 
properly a legal and not a medical term. There are a number of diseases 
which may be grouped under this head, and of late these ha\e been termed 



Fig. 239. Operating-Room in the Government Hospital for Insane, Washington, D. C. 


the psychoses , or diseases of the mind. Diseases of the mind are not different 
in any sense from diseases of other organs of the body, the only variation 
being that the symptoms are different because the functions of the brain- 
substances are not like those of other organs. Thus, irritation in the lung 
will cause a cough; while a similar irritation of the brain-substance, which 
may be occasioned by the same factor (pneumonia-bacteria), may give rise 
to delirium. It is highly important that the layman should recognize that 
mind-diseases are precisely like any other kind of diseases, and that a person 
who suffers from an acute attack of mania is not different from one who 
suffers from an acute pneumonia, and that he should be looked after with 
as much, if not more, care. Locking him up in a madhouse is inhuman 
and unnecessary. There is too much superstition still present in the minds 
of men regarding mental diseases. It would seem that the majority of even 


















469 


THE STANDARD FAMILY PHYSICIAN insanity 

intelligent laymen had not progressed beyond the point when people with 
mental disease were thought to be “possessed of the devil.” 

Insanities are of various kinds. Just as with other diseases, some cases 
are very mild, others very severe. The differences in the structures and 
functions of the various parts of the nervous system will account for the 
variations. As a rule all mental disorders run a more protracted course 
than bodily disorders, because of the finer and more complicated nature of 
the mind-substances. Briefly expressed, perception, thinking, and acting 
are the chief mental functions, and in the various forms of insanity the 
symptoms involve these functions. 

The disorders of perception comprise: (i) Illusion , or the false interpre¬ 
tation of things actually seen, a condition not at all uncommon in normal 
life. (2) Hallucination, or a perception which has no real foundation. 
Many hallucinations aie due to defects in the eye, ear, nose, or other organ 
of sense; and in some insane people it may be possible to discover the defect 
by careful examination, and to remove it by intelligent treatment, thus 
effecting a cure. (3) Clouding of consciousness , a defect of perception, 
whereby outside impressions are received with difficulty or not at all. 

The disorders of thinking are more complex. Some of the most impor¬ 
tant symptoms are: (1) Delusions , or false beliefs. These are not in them¬ 
selves sufficient evidence of any one type of the insanities. (2) Obsessions , 
or impulsive ideas, or fixed ideas. These are very common; and if uncon¬ 
trolled, or not educated out of the patient, they often result in mental 
breakdown. (3) Dream states , a condition in which the ideas are dreamy 
and ill-defined. (4) Flight of ideas , a symptom characterized by the phe¬ 
nomenon that the train of thoughts, instead of leading to a definite end, is 
diverted and jumps from one subject to another. (5) Retardation , extreme 
slowness of thinking which may go on to paralysis of thought. 

The disorders of action may be characterized by: (1) Intense psycho¬ 
motor activity , seen in violent patients; or there may be (2) psychomotor 
depression , the reverse condition. A third symptom is (3) stereotypy , or the 
repetition of motions. In addition to these common symptoms, the emo¬ 
tional tone may be exalted, or depressed, or degraded; the memory maybe 
defective or exaggerated. Among the many different forms of insanity the 
following chief types may be mentioned here: 

1. Infection Psychoses.—These are such as follow, or occur during, typhoid 
fever, pneumonia, or other acute infectious diseases. Confusional mental 
states, with delirium, hallucinations, etc., are very common in the infection 
psychoses. Many patients recovering from a severe illness refuse to take 
their medicines. They are suspicious, and fear they are being poisoned. 
The appearance of such a symptom should be regarded as a sign that the 
effects of the original disease have been very marked on the mental organs, and 
should call for a greater care during the convalescence of these patients, or 






Insanity 


THE STANDARD FAMILY PHYSICIAN 


470 


else a mental defect may persist, perhaps permanently. These patients are 
not well even when they seem to be well} and they should be kept as conva¬ 
lescents longer than the attending physician himself may think necessary, 
unless he is a specialist in nervous and mental disorders. 

2. Toxic Psychoses.—These may follow alcoholic intoxication, diabetes, 
Bright’s disease, the habitual taking of opium or cocain, and various other 
forms of poisoning. The alcoholic insanities are extremely numerous and 

very complicated. 

3. Paranoia.—This is the type of insanity which the lay mind often 
associates with craziness or madness. Usually this disease runs insidiously 
and is incurable. The delusions may or may not spring from sensory 
illusions. When they exist without sensory illusions, they are generally 
found in persons who from their earliest childhood have been abnormal, 
eccentric, and peculiar. Their peculiarities become more and more pro¬ 
nounced. To this class belong inventors who claim to have solved the prob¬ 
lem of squaring the circle, or the problem of perpetual motion; also the 
“Saviors” and “Messiahs,” the “Salvationists” and “Health Apostles,” the 
persons who are jealous without cause, the individuals of “noble descent” who 
lay claim to this or that throne, and the erotomaniacs who believe themselves 
beloved by persons of high position and overwhelm them with effusive 
letters. Such persons frequently possess a fine rhetorical gift, as a conse¬ 
quence of which they always find some stupid followers who swear by them; 
and during times of political or religious excitement such persons may 
therefore bring some influence to bear upon the excited masses. The 
border-line between normal and abnormal persons is very hard to determine 
in such cases. Many founders of religions have been paranoiacs. 

Delusions in consequence of sensory illusions are readily recognized as 
abnormal even by the layman. There are two main groups in these para¬ 
noias: the delusions of persecution and those of egotism. Both conditions 
may be found in the same patient. The disease develops very slowly. The 
patient begins to be suspicious and distrustful; he believes every remark to 
have a personal allusion, feels himself “observed,” and everything seems to 
him to have a double meaning. Sensory illusions follow these first symp¬ 
toms. The patient hears threatening words, secret whisperings, and sees 
people talking about him; and through the incessant repetition of these 
wrong impressions he becomes fully convinced that there is a “grudge” 
against him. The patient believes he is being followed, and he muses and 
worries about the cause of this persecution and about his enemies. At one 
time he may imagine them to be masons, then Jesuits, then the police, or 
the Social Democrats. After a time he will imagine certain individuals to 
be inimical to him, and will make efforts to guard himself against them, 
either by announcement to the public prosecutor or by personal force, even 
with the aid of weapons. This frame of mind transforms the patient him- 





471 


THE STANDARD FAMILY PHYSICIAN 


Insanity 


self into a persecutor, and a very dangerous one at that. At this stage of 
the condition the patient is generally placed in an asylum, where, after 
months or years, his ideas of persecution develop into a regular system. 
When this stage has been reached the condition is beyond help. At last, 
sometimes after decades, the patient becomes quiet and indifferent; he has 
resigned himself to his fate; his delusions become more and more disjointed 
and confused, until finally his sad plight ends in a state of dementia. 

The so-called querulous paranoia is a form of paranoia which is of prac¬ 
tical importance, and which is often misunderstood. It is not the quarreling 
and faultfinding that characterizes this form of insanity, but the manner of 
doing it. There are plenty of persons who are forever defending with stub¬ 
born tenacity their actual or supposed rights, without ever being thought 
mentally unsound. Yet there is a difference between the mentally sound 
and the unbalanced. The one of sound mind discontinues his case as soon 
as all appeals have been exhausted, and does not suspect every legal decision 
of being based on malice, selfishness, bribery, and treachery. In the 
querulous person of unsound mind there develops a systematic train of 
ideas of persecution. He believes all his adversaries to be rascals or knaves, 
the judges to be dishonorable and corruptible, the witnesses to be perjurers. 
He sends addresses and complaints to high officials, and receiving no hearing 
he becomes insulting; he is punished, but continues his insults in spite of 
sad experience or good advice. Like those insane persons with ideas of 
persecution already described, the querulous paranoiac believes himself to 
be the victim of a plot; his rights are disputed, he has enemies who seek his 
undoing, but he will and he must conquer them. He squanders his entire 
fortune in the “preservation of his interests”; he writes violent articles to 
the newspapers; and he assumes the role of savior of distressed mankind. 
If the court pays no attention to him and his insults, he resents the ignoring 
of his complaints; and he will commit penal acts, shoot innocent people, or 
smash show windows or mirrors for no other purpose than to get aiiearing 
and again to plead his “rights” in court. In this way the affair is drawn 
out for years and years. 

If the paranoiac finally is placed under the care of a guardian or in an 
asylum, he finds fresh opportunity for endless complaints and troubles on 
every occasion. Of course the alienists are in the plot; they also are his 
enemies and act only from personal motives. Many pamphlets which issue 
from asylums, entitled “Incarcerated Innocently” or “The Modern Vehmic,” 
come from the pens of these paranoiacs. They are often cleverly written, 
and find readers who believe in the writer and in his prejudiced representa¬ 
tion (for who is not ready to give credence to evil lepoits!), and these cred¬ 
ulous readers wonder how such an intelligent man can lie put into an 
asylum. But the fact that these insane persons cut sorry figures in the 
asylums, and that every alienist would be overjoyed if he could with good 




Insanity 


THE STANDARD FAMILY PHYSICIAN 


472 


conscience let these lunatics loose upon the world to fresh deeds of foolish¬ 
ness, should warn the public against false impressions and ugly suspicions. 
The querulous paranoiac as described is actually sick, for he suffers from 
the delusion of persecution. That he is everywhere at a disadvantage and 
is treated unjustly has become a settled fact to him. This belief has become 
incorrigibly “fixed” in him; and this differentiates the condition, like all 
other forms of delusion, from simple misunderstanding which can always be 
corrected by the intellect. This idea dominates his thoughts, his feelings, 
and his will, and stamps upon his personality the seal of mental disease. 
These paranoiacs are nearly always dangerous lunatics. What makes them 
more dangerous is that the untrained mind can not perceive the kind of 
sickness from which they suffer. Even judges do not know this type as well 
as they should. 

4. Dementia Praecox.—This is an important type of mental disease. It 
is a form of mental breakdown in the young. The French speak of it as 
“stranded on the rock of puberty,” since so many young people go to pieces 
at that time. This is a disease which fathers and mothers should under¬ 
stand, for it may at times be avoided by adopting a proper mode of living 
for their children at the first signs of its outbreak, and thus save them for a 
life of usefulness. The disease usually begins with mental depression and a 
mild grade of confusion. The afflicted find it hard to take interest in their 
books, and there is a tiring of voluntary attention (to be distinguished from 
the laziness of children) which is present even in their play. The memory 
becomes impaired, particularly with regard to recent events; and a certain 
emotional deterioration begins to take place. Dementia praecox is a very 
prevalent type of mental disease. It may be recognized early by experts, 
and a lifelong dementia and wasted life be avoided. 

5. Manic-Depressive Insanity.—This is a prevalent mental disease 
which corresponds to the disorder which earlier medical authors termed 
circular insanity. Many authors have also used the terms mania and mel¬ 
ancholia for this disease. Conditions of depression are often encountered 
in the insanities. Manic-depressive insanity, however, is an independent 
disease which has a well-defined course, and which is strictly differentiated 
from all the other forms of insanity. It is characterized by an afflicting 
psychic depression, with great loss of self-reliance, alternating with states of 
excitement. From the psychic grief of the healthy it is distinguished by 
either absence or insignificance of external cause, or by the force with which 
the entire mental and psychic life of the affected person is made subject to 
the condition for weeks and months. For instance, a mentally sound 
mother who bewails the death of her child will never, deep as her grief may 
be, become fully the slave of her sorrow; she is able after a time to console 
hc^rself and to master her sentiments. Not so, however, the melancholic. 
Her train of thoughts is riveted to one single point; she has no room for 





473 


THE STANDARD FAMILY PHYSICIAN 


Insanity 


other interests; her entire imagination is obstructed; her energy relaxes; and 
whatever she may experience becomes a new source of grief. A very good 
example of the transition from the normal to the morbid is presented by 

homesickness , which sometimes actually assumes the character of well- 
developed melancholia. 

In many cases the melancholic does not know any reason for his grievous 
depression. Sometimes, however, the searching and brooding over the 
source of his gloom gives rise to various morbid ideas; he imagines having 
committed a sin, and he believes himself to be the most wicked person on 



Figs. 240, 241. Characteristic facial expressions in manic-depressive insanity. 


earth, one who will never be able to gain eternal beatitude, but be forever 
cursed. Or he may fancy that he is impoverished, or that he is suffering 
from an incurable disease. These thoughts are often added to an anxiety 
which may become so intense that it leads to acts of violence, to suicide, 
self-mutilation, or even to bloody deeds against others. The tormenting 
tension in which the patient has been so far, is broken in this case, about in 
the same manner as high pressure of steam explodes the boiler. Terrible 
delusions are also as a rule present in such instances. The patient imagines 
that he beholds his murderers; he hears the gallows prepared for him; he 
sees hell with all its terrors; or he hears his children call anxiously for help. 

Such depressed patients are dangerous to the utmost. It should be borne 
in mind that even those patients who are apparently but slightly depressed 
should never be trusted; for persons who silently suffer their torments, and 
who for some time do not manifest any symptoms, are the very ones who 
often end their lives by suicide. Hence, all melancholics, without excep¬ 
tion, must be carefully watched, and should be under supervision by night 











Insect Stings 
Intestines 


474 


THE STANDARD FAMILY PHYSICIAN 

as well as by day. They require rest and a very careful psychic treatment 
which, combined with strict watching, can generally be offered only by the 
trained nursing as practised in an institution. Nothing is accomplished, 
at least in the severe cases, with the constant “intention to console,” even 
with religious comfort. It would be a still greater mistake to attempt to 
“cheer up” the patient by amusing him. This would be quite as nonsen¬ 
sical and cruel as sending a mother grieving for the death of her darling to 
see a comedy. The depressed periods may persist for several months, and 
then the patient may gradually emerge from his gloom and become normal. 
These patients, however, may develop other attacks of the same kind, or 
they may become mildly maniacal, or wildly excited. The maniacal attacks 
may last a few months, and then clear up as did the melancholic attack. 
The usual history in these cases is to have several attacks of the disease. 
Usually the successive illnesses result in some grade of mental deterioration. 

Other forms of insanity are general paresis (for which see the article 
Brain, Softening of), and senile dementia , which is treated under 
Senility. See also Mental Diseases. 

INSECT STINGS AND BITES.—The stings of bees, wasps, and hornets 
cause redness and swelling of the skin, which usually recede in a few days. 
Occasionally, when one eats fruit carelessly, the insects may reach the 
mouth or throat, where their stings often cause great pain. In exceptional 
cases swelling of these parts has caused death by suffocation. Individuals 
who are very susceptible to the poison of bees, as well as persons who are at¬ 
tacked and stung by a whole swarm, may manifest severe general symptoms, 
such as fainting, chills, nettle-rash, vomiting, and diarrhea. Treatment 
consists in touching the swollen parts with diluted spirits of sal ammo¬ 
niac, or in the application of bicarbonate of soda. Bee-stings sometimes 
remain in the wound. When this is the case they should be removed with 
a needle, care being taken to avoid breaking the poison-gland which often 
adheres to the upper part of the sting. If the mouth is slimy, the sucking of 
small pieces of ice will give relief. 

Diluted spirits of sal ammoniac, and baking-soda are efficacious also in 
cases of bites by tarantulas, scorpions, mosquitoes, etc. Protection against 
the nightly invasion of mosquitoes is afforded only by fine wire- or gauze¬ 
netting. Lead-water is a good application in cases of ant bites. 

Bees, wasps, and hornets sting only when they are irritated. Striking 
at them does not drive them away, but, on the contrary, renders them 
furious. It should, therefore, be avoided; and children should be especially 
cautioned against destroying the nests of these insects. The best protection 
in case of an attack by a swarm of bees is to keep absolutely quiet. 

INSOMNIA.—See Sleeplessness. 

INTERCOSTAL PAINS.—Pains due to disturbances of the activity of 
the intercostal nerves. They occur in single attacks on one side of the chest, 






° THE STANDARD FAMILY PHYSICIAN insect stings 

---_---- Intestines 

especially on the left, and may increase in severity from time to time. They 
may be due to various causes, such as cold, diseases of the sexual* organs, 
anemia, diabetes, nervous conditions, diseases of the vertebral column or 
of the ribs, etc. Sometimes they occur without any evident cause. The 
Pams set m suddenly, and are so severe that the patient believes he is suffer¬ 
ing from pleurisy. They are increased by violent movements of the thorax, 
such as those caused by coughing or by deep breathing, and also by pressure 
at evacuation of the bowels. Examination generally reveals three localities, 
or aieas, where the pains are most severe; namely, the parts adjacent to the 
\ertebral column, the sternum, and the intermediate space. Intercostal 
pains are conspicuously frequent in conjunction with herpes. The disease 
may be alleviated by the application of blistering agents (such as spraying 
with ethyl chlorid), warm poultices, massage, and electricity. Occasionally 
this condition is very stubborn, but as a rule it terminates favorably. Atten¬ 
tion must always be paid to constipation. If the condition be due to any of 
the diseases mentioned above, the causative affection must naturally be 
treated. In such cases the final outcome will depend upon the nature and 
course of the fundamental disease. 

INTERMITTENT FEVER. —See Malaria. 

INTESTINAL WORMS. — See Filaria; Parasites; Tapeworm; 
Worms. 

INTESTINES. —For anatomy and structure see Introductory Chap¬ 
ters (pp. 56-57). 

INTESTINES, DISEASES OF. —There are a number of affections of the 
intestines. The most important are Constipation (which see), intestinal 
catarrh, intestinal occlusion, tuberculosis of the intestine, and tumors of the 
intestine. Certain diseases in which the intestines are mainly involved, are 
discussed under their respective headings. See Cholera; Dysentery; 
Typhoid Fever; etc. 

Intestinal Catarrh. —There are two main forms of this complaint: the 
acute, in which recovery takes place in a few days or weeks; and the chronic, 
which may extend over months or years. Among the causes of the acute 
type may be mentioned exposure, indiscretions in diet, and poisoning due to 
foodstuffs or bacterial toxins. Errors in diet are the most frequent cause, 
and the condition is therefore most prevalent in the summer months. Intes¬ 
tinal catarrh arises in the same manner as an attack of Cholera Morbus 
(which see), but in the former disease the stomach is involved but slightly, 
or not at all. The strange fact that dietary indiscretions, and even contami¬ 
nated food, may produce no symptoms in the stomach, is very likely due to 
the circumstance that in most persons the stomach is more resistant than 
the intestine. This is undoubtedly due to the fact that the gastric juice 
contains hydrochloric acid, which possesses germicidal and anti-fermenta¬ 
tive properties. Moreover, the stomach has the property of being able to 









Intestines 


THE STANDARD FAMILY PHYSICIAN 


476 


empty itself quickly in either direction if it contains any harmful materials. 
In the intestine such materials remain for a longer period, and a greater 
opportunity is thus afforded for irritating the sensitive mucous membrane. 
As a rule the disease process does not involve the entire length of the intes¬ 
tine, but affects only certain portions, such as the large or the small intestine, 
or perhaps only certain segments of these. The symptoms, however, may 
be very serious even if only one-tenth of the entire intestinal tract be involved. 

The catarrhal process consists essentially of a free exudation of water 
and mucus from the inflamed membrane, together with a tendency to bleed¬ 
ing. Where the lower segments of the gut are affected, this mucus may be 
readily recognized, as it coats the fecal masses like varnish; or if the feces 
are soft or fluid, it makes them stringy. The higher the seat of the disease, 
the more intimately does the mucus become mixed with the feces; and in 
certain cases it may therefore be detected only by the aid of the microscope. 
Even more characteristic than the presence of mucus in the stools, is the 
soft and thin character of the feces. From a semisolid consistency the 
evacuations gradually become quite fluid, and contain merely water, mucus, 
and intestinal secretions. On account of the increased peristalsis which is 
characteristic of this disease, the food passes through the intestine very 
rapidly. The stools also contain unchanged biliary secretions; and instead 
of their normal grayish-brown color, they appear green. In the presence 
of intestinal catarrh, unchanged parts of the food are excreted within a few 
hours; whereas under normal conditions the undigested food particles, 
which are too small to be readily recognized by the naked eye, do not appear 
in the stools until after an interval of from twelve to twenty-four hours. If 
this incomplete digestion continues for any length of time, nutrition becomes 
impaired and the body soon loses in weight. This loss is noted even where 
an intestinal catarrh has been present for a few days only. 

The acute form of intestinal catarrh begins quite suddenly with abdom¬ 
inal pain, colic, and other disagreeable sensations. There may be fever, 
especially at the beginning of the attack. The appetite is poor, and the 
patients usually express an abhorrence of all food. An excessive thirst 
soon appears; but this should not be satisfied, as the ingestion of any quantity 
of water simply increases the number of the stools. These may follow one 
another so closely that the individual is permitted scarcely any rest, and is 
constantly bothered by the distressing desire to empty his bowels. This 
profuse diarrhea greatly weakens the patient. 

Chronic intestinal catarrh usually develops from an acute attack which 
has been neglected. The transition from one form to the other is often 
unobserved, for although the abdominal pains diminish, the diarrhea con¬ 
tinues, although it becomes less severe. The feces become somewhat more 
solid, and in some cases constipation may be present for a few days, only 
to be succeeded by an increased diarrhea. The longer the duration of the 




THE STANDARD FAMILY PHYSICIAN 


Intestines 


4 

4 / / 


catarrh, the more the intestinal glands lose their power to absorb the nutrient 
materials of the food, and a large portion of the latter is excreted unchanged. 
The patient s nutrition becomes affected to such an extent that he presents 
an alarming picture of emaciation. The skin becomes dry and hard, the 
complexion pale, the urine scant, and the strength diminished. An organ¬ 
ism weakened in this manner soon loses its powers of resistance, and the 
individual readily succumbs to any intercurrent disease. Chronic intestinal 
catarrh may be combined with other diseases, especially with chronic 
catarrhal gastritis, in which affection the inflammation simply extends from 
the stomach down into the intestine. Cardiac and pulmonary complica¬ 
tions may likewise set in, and in this way the prognosis is rendered still 
more unfavorable. 

In treating the acute form of intestinal catarrh, rest in bed and a re¬ 
stricted diet are among the most essential requirements. Complete absti¬ 
nence from food is the best course to follow on the first day, or the patient 
may be given warm fluids, such as gruels, tea, or milk, and soft-boiled eggs. 
After the severe symptoms have subsided, zwieback, white bread, toast, 
rice, farina, etc., may be administered. Hot, and preferably dry, abdom¬ 
inal applications afford the patient a great deal of comfort; they alleviate 
the pain and favor the process of healing which usually occupies from three 
to fourteen days. In order to prevent recurrences, the patient must exercise 
care in eating, even for some time after his recovery. If the trouble is 
known to have been brought on by some dietary indiscretion, it is advisable 
thoroughly to clear out the intestinal tract by the administration of a brisk 
cathartic which, if necessary, may be followed by some astringent remedy. 

The treatment of the chronic form demands strict adherence to a care¬ 
fully prescribed diet. Even a neglected case may be greatly improved by 
following such a course for from four to six weeks. When the intestinal 
glands have become completely atrophied, a complete cure can no longer be 
expected. When obstinate cases of diarrhea occur in apparently healthy 
persons, notwithstanding a selected diet, it is more frequently due to the 
presence of a malignant tumor in the intestine than to a mere chronic 
catarrh. The main rules for dieting these cases may be summarized as 
follows: Vegetables, fruits, cake, spices, sugar, sour and sweet dishes or 
drinks, beer, wine, brandy, rye-bread, fatty meat, cheese, lobsters, and a 
number of other articles, are to be forbidden. It is permitted to take milk 
(if no unfavorable effects are observed), soup, gruel, rice, sago, tapioca, 
farina, white bread, toast, zwieback, crackers, eggs, lean meat or fish, tea, 
cocoa, chocolate, claret, and selters which has ceased effervescing. The 
abdomen should always be kept warm by means of a woolen bandage. 
Warm applications, sitz-baths, and complete body baths aie also of value. 
The necessary drugs must be prescribed by the physician. In obstinate 
cases irrigations of the colon may be tried. 







Intestines 


THE STANDARD FAMILY PHYSICIAN 


478 


Intestinal Catarrh in Children.— In addition to the very acute and severe 
form of catarrh of the gastro-intestinal tract, known as Cholera Infantum, 
infants may be subject also to a more chronic type, which lasts for a consid¬ 
erable time and resists most forms of treatment. It may develop from the 
acute variety, or it may assume a chronic form from the very beginning. 
The most frequent cause of these chronic catarrhs is errors in diet, either 
with regard to its quantity, its character, or its composition. 

In a nursing infant it is almost invariably the quantity of the food which 
produces the trouble; and the composition of the mother’s milk is rarely at 
fault. Very often the child is given the breast too frequently, on the mis¬ 
taken supposition that a child must needs be hungry every time it cries. 
This causes overfilling of the stomach, and likewise of the remainder of the 
alimentary canal, and gives rise to attacks of spasmodic colic. When the 
colicky pains cause the child to cry, an inexperienced mother simply offers 
her breast to the infant again, thus bringing about further stuffing. This 
increases the trouble and favors the development of a chronic intestinal 
catarrh. The quality of the milk is affected by suppurative inflammation of 
the breast; or if the mother allows her milk to become contaminated on 
account of lack of cleanliness. The composition of the milk may be changed 
by conditions of nervous excitement or by febrile diseases. 

In artificially nourished infants, an excessive quantity of food is likewise 
an important factor in causing acute as well as chronic catarrhs. The 
disease may be caused also by giving the child milk which is either too thin, 
or not sufficiently diluted, during the early months; or it may arise from 
feeding it with farinaceous gruels before its stomach is able to digest such 
food. The presence in the food of an excessive amount of fat may assert 
itself in a fatty diarrhea. An attack of cold is also a frequent source of this 
trouble. Another cause which is often undervalued, but nevertheless im¬ 
portant, is lack of cleanliness on the part of the nurses, either with regard to 
their own persons or with the child. It must not be forgotten that intestinal 
catarrhs may occur also as accompaniments or complications of other 
diseases, especially of rickets. 

One of the first indications of a gastro-intestinal catarrh is the child’s 
lack of appetite. This symptom, however, is often overshadowed by its 
excessive thirst, under cover of which the food may all be ingested. The 
abdomen then becomes distended and tender, and the child draws its legs 
up, and cries or moans constantly in a most pitiful manner. At first the 
stools are merely increased in number, but show little change in appearance. 
Later, however, they become curdled and green, are mixed with mucus, and 
have a foul odor; finally they become fluid, and are then passed with a great 
deal of gas. A small number of children survive the first attack and get 
well; but the majority develop a chronic catarrh from which they may 
suffer for prolonged periods before recovery takes place. Death may result 






479 


THE STANDARD FAMILY PHYSICIAN 


Intestines 


from progressive emaciation, and from the effects of the toxic materials pro¬ 
duced in the intestine. Sometimes the thin, foul, mucous stools may alter¬ 
nate with aparently normal evacuations. Aside from the character of the 
stools, the most noteworthy symptom of intestinal catarrh is the marked 
emaciation which takes place. All the fatty tissue is lost, so that the poor 
little mite gradually gets the appearance of a skeleton covered with skin. 
Boils frequently develop, and also bed-sores in the region of the buttocks, 
the genitals, or the heels. The voice of the constantly crying, restless and 
sleepless child becomes more and more hoarse, and finally is nothing but 
an indistinct moan which in most cases is stilled by death. 

In the treatment of an infant ill with gastro-intestinal catarrh, it is ex¬ 
tremely important to follow the advice of a physician. The food, which also 
serves as medicine, must be prepared with the greatest care and precaution, 
with regard to its character as well as to its cleanliness, and no heed should 
be given to advice tendered by any other person than the physician. The 
excessive thirst may be relieved by bland drinks, and the best of these is 
boiled water to which may be added a teaspoonful of granulated sugar to 
every pint, or a thin infusion of black tea. The tea is prepared by pouring 
a pint of boiling water over a teaspoonful of tea, straining after two minutes, 
and then sweetening with a lump of sugar. This may be taken warm or 
cold. The sick children must be kept in a clean bed, and soiled linen should 
be immediately replaced, for in this way bed-sores and furuncles may best 
be avoided or, if already present, may be prevented from becoming worse. 
The soiled napkins should be kept for the inspection of the physician, so 
that he may note the character and progress of the disease. The most im¬ 
portant prophylactic measure is to provide pure milk from a well-conducted 
dairy; and then to observe scrupulous cleanliness with regard to the body 
of the child and all objects with which it comes in contact. In older children 
the course of the disease does not vary greatly from that observed in adults. 

Intestinal Hemorrhage.— The significance of this condition varies accord¬ 
ing to the locality from which the bleeding proceeds. Blood which flows 
from the anus may be derived, not only from various portions of the intes¬ 
tine, but also from the stomach. Its color and composition vary with the 
extent of intestine which it has to traverse before it reaches the exterior of 
the body. The hemoglobin is disintegrated by the intestine, wherefore the 
blood loses its red color; and if it comes from the stomach or from the upper 
portions of the small gut, it is quite black when it reaches the anus, and gi\ es 
the stools a very dark or tarry appearance. Blood from the colon remains 
more or less mixed with the intestinal contents, without losing its distincti\e 
red tint, so that it renders the stools reddish-brown or chocolate-colored. 
In doubtful cases the admixture of blood in the stools may be detected only 
by chemical analysis. Even very old, black blood, in which the red blood 
corpuscles can no longer be recognized by microscopical examination, may 



Intestines 


THE STANDARD FAMILY PHYSICIAN 


480 


be diagnosed with absolute certainty by chemical tests which reveal the 
presence of the coloring-matter, the hemoglobin. Bright red blood can 
come only from the lower segments of the intestinal canal, particularly the 
rectum, in which case it does not become mixed with the fecal matter, but 
is deposited on the outside of the mass. These variations in the color of 
blood passed with the stools are of great importance in determining the site 
of the hemorrhage. 

The most frequent cause of bleeding from the intestinal canal is the 
presence of piles, or Hemorrhoids (which see). Rectal hemorrhages may 
be due also to catarrhs or ulcers of the mucous membrane of the rectum, but 
in such cases the blood passed is much less in amount, and is always mixed 



Fig. 242. Intestinal occlusion. Fig. 243. Intestinal occlusion. 

(A loop of gut displaced sidewise.) (A loop of gut displaced upwards.) 


with mucus. Rectal bleeding is not uncommonly the first sign of cancer of 
this portion of the gut; and the condition is very often neglected because it 
is believed to be due to hemorrhoids. Continued intestinal hemorrhages, 
however slight, always require a careful examination of the rectum. Ulcers 
or tumors in the colon may likewise give rise to intestinal hemorrhage, and 
the appearance of this symptom may often serve as the first indication of 
their presence. In these cases the bleeding occurs because the walls of the 
blood-vessels which traverse the sloughing growth become involved in the 
process of destruction, and consequently rupture. Bleeding due to ulcers 
or tumors can be stopped only by curing the ulcerative conditions, or by 
removing the tumors. 

Intestinal Occlusion. — Volvulus and intussusception are closely related 
pathological conditions, in which the fecal stream is halted at the site of an 
obstruction so that no further evacuations are possible. Above the point of 
occlusion an accumulation of fecal material takes place, and this finally 
reaches such a degree that a reversal of the usual peristaltic current forces 
it back into the stomach, from which it is eventually vomited. Fecal vom- 









481 


THE STANDARD FAMILY PHYSICIAN 


Intestines 


iting is a symptom much dreaded by the physician, and in order to avoid it 
recourse must be had as early as possible to means for providing a natural 
exit. The attempt should first be made with enemas of various kinds and 
high rectal irrigations of warm water. These are sometimes successful in 
restoring the patency of the bowel. If constipation persists, it becomes 
necessary to seek surgical assistance. This is applied to the production of 
an artificial anus, usually on the right side of the lower portion of the abdo- 



Fig. 244. Intestinal intussusception. ... 
(Introversion of a portion of the intestine into the adjoining part.) 



Fig. 245. Intestinal intussusception. (Showing cross-section of Fig. 244-) 


men (see Anus, Artificial). Through this artificial opening the feces are 
excreted, and are collected on pads of gauze or cotton which must be 
frequently renewed, or in specially constructed receptacles. When the ob¬ 
struction has been removed and the lumen of the canal is again patent, the 
artificial anus can be closed; otherwise it must remain open permanent y. 
Intestinal occlusion may come on suddenly or gradually. _ The acu e 

variety may arise from the twisting of a loop of gut, from the inteitwis mg 
J y 1 17, 2A%) or from the introversion of one 

of two or more loops (see iMgs. 242, 2431, or 1 o 

segment of gut into another of larger diameter (see Figs. 244, 245)- 








Intestines 


THE STANDARD FAMILY PHYSICIAN 


482 


peristaltic movement is interrupted at the site of the obstruction; and it may 
even be reversed towards the stomach and produce fecal vomiting as already 
described. The intestinal coils above the occlusion become distended with 
gas and fecal matter, and the whole abdomen, or a part of it, becomes 
inflated like a drum. Inflammation of the peritoneum may set in, owing to 
the growth of bacteria in the swollen walls of the intestine. Where the occlu¬ 
sion is due to the gradual encroachment of a tumor, the symptoms are devel¬ 
oped more slowly and are less severe in character. Weeks or months may 
elapse before obstruction results; and this may be only temporary at first, 
but is certain to recur after a longer or shorter interval, and then becomes 
permanent. 

Intestinal Tuberculosis.—In this disease the tuberculous process is 
localized in the intestine. It usually appears as a part of a generalized 
tuberculosis and is rarely the primary focus of the disease. It is character¬ 
ized by the development of numerous ulcers of varying size, principally in 
the small intestine. These ulcers result from the disintegration of the so- 
called tubercles, a name given to the little nodules which are due to the 
growth of the tubercle-bacilli. In patients afflicted with pulmonary con¬ 
sumption the bacteria gain entrance to the digestive system by being swal¬ 
lowed with the sputum. More rarely they may enter the intestinal tract 
by the ingestion of infected food, such as milk from tuberculous cattle. The 
development of intestinal tuberculosis in this manner probably occurs only 
in children. The tubercle-bacilli are especially liable to invade the mucous 
membrane of the intestine if a catarrhal condition is present. Months may 
elapse, however, before the ulcers are formed. The ulcerative process 
gradually extends into the deeper layers until the serous coat is reached, 
when perforation into the free abdominal cavity may take place, causing 
a suppurative peritonitis which rapidly becomes fatal. More commonly, 
however, the ulcers extend in a lateral direction and may cover the entire 
internal circumference of the gut, leading later to the formation of cica¬ 
tricial contractions of the lumen of the intestine. Small adjoining ulcers 
have a tendency to coalesce and form one large ulcer. 

Tuberculous ulcers may exist in the intestine without giving rise to any 
symptoms. As a rule, however, abdominal pain is present, and very often 
fever, but the most characteristic symptom consists in attacks of uncon¬ 
trollable diarrhea. It frequently happens that the patient has from three to 
ten thin, fluid movements a day, as a result of which he rapidly becomes 
weak and emaciated. Together with the rapidly progressing pulmonary 
tuberculosis, the condition usually ends fatally within a few months, although 
occasionally it may linger for half a year. 

The treatment of intestinal tuberculosis constitutes one of the most 
difficult problems in medicine. A strict diet, similar to that prescribed for 
chronic intestinal catarrh (which see), is necessary. Rest in bed, and the 




483 


THE STANDARD FAMILY PHYSICIAN 


Intestines 


continued application of heat to the abdomen are also of value. Among 
drugs, the best results have been obtained with tannic acid or its derivatives, 
taken m powder form so that they may reach the gut undissolved and afford 
protection to the ulcerated surfaces. Bismuth is also employed; and like¬ 
wise a number of other drugs. By careful treatment it is sometimes possi¬ 
ble to alleviate the diarrhea for a time, but recurrences are very frequent. 
As the pulmonary tuberculosis improves, a change for the better is often 
seen in the intestinal conditions. 

Intestinal Tumors.—Both benign and malignant growths are found in 
all parts of the intestinal tract from the duodenum down to the rectum. Of 
the two varieties, the former is the rarer. Benign growths are mainly 
polypi, and are situated in the small intestine where they form one or more 
finger-like proliferations of the mucous membrane, which are soft, freely 
movable, and of varying sizes. These are frequent sources of hemorrhage, 
and may lead also to constrictions or invaginations of the intestine. As a 
rule, however, they are harmless, and do not endanger life. The first 
symptoms of their presence become manifest only when they interfere with 
the patency of the intestinal canal, causing transitory or permanent occlu¬ 
sion of the gut, which may end fatally unless receiving prompt and energetic 
medical attention. Rectal polypi are the easiest to treat, because they may 
commonly be removed through the anal opening, while those situated higher 
up usually require an abdominal section. 

The malignant tumors of the intestine are almost without exception 
cancerous. Their most frequent sites are the colon and the rectum, but 
they are sometimes found also in the small intestine. They may reach the 
size of a man’s fist, and may lead to extensive adhesions between the intes¬ 
tinal coils and the surrounding regions. These tumors are hard, present 
an uneven or nodular surface, and may often be palpated through the ab¬ 
dominal wall, when they may be felt to be more or less movable. Under 
certain circumstances these tumors may not give rise to any marked symp¬ 
toms for months; and the first signs of trouble do not appear until they have 
grown to such a size that they exert pressure on neighboring organs, or 
produce a narrowing of the lumen of the gut. This results in pain, repeated 
attacks of intestinal colic, hemorrhages from the bowel, and diarrhea. 
The patient becomes pale and markedly emaciated. If a permanent occlu¬ 
sion of the gut has resulted, which interferes with the passage of the intes¬ 
tinal contents, the movements of the intestine, as well as the distended loops 
of gut, may become visible on the surface of the abdomen. These appear¬ 
ances are due to the stoppage of the intestinal contents at the point of con¬ 
striction, where the peristaltic action ceases because further propulsion is no 
longer possible. Where the occlusion takes place suddenly, fecal vomiting 
results, and death may come on very quickly. When obstinate constipation 
occurs in middle-aged people whose evacuations have formerly been per- 









Intestines 

Iodin 


THE STANDARD FAMILY PHYSICIAN 


484 


fectly regular, suspicion should always be directed to the possibility of an 
intestinal tumor being present. This state of constipation may be inter¬ 
rupted from time to time by periods of diarrhea, but this is merely due to a 
transitory restoration of the patency of the lumen of the bowel. The intes¬ 
tinal tumors of most frequent occurrence are cancers of the Rectum (which 
see). Growths which have their site at the beginning of the colon, especially 
if they are small, may give rise to symptoms resembling those due to chronic 
appendicitis. 

The only effective remedy for intestinal tumors is their removal by the 
surgeon’s knife. Success, however, can be hoped for only in the cases of 
smaller tumors, where no adhesion to the surrounding structures has oc¬ 
curred, and where no cancerous deposits have taken place in other portions 
of the body. Operation must not be delayed until the patients have become 
emaciated, but should be carried out at the appearance of the first definite 
evidences of the disease. 

Intestinal Ulcers.—These occur on the inner surface of the gut, and are 
of varying sizes and shapes. At first they are no larger than a pin-head, but 
gradually they may become as large as a quarter. In shape they are circu¬ 
lar or oval, and rarely irregular in outline. They are always developed in 
the mucous membrane, and usually remain restricted to this. Sometimes, 
however, they penetrate the muscular coats and finally the peritoneal cover¬ 
ing of the intestine. Whenever the serous coat of the gut is involved, there 
is constant danger of perforation into the peritoneal cavity. The entrance 
of fecal matter into this cavity brings about a purulent peritonitis which 
rapidly proves fatal. This accident, however, is often prevented by the 
fact that the irritation produced by the gradually deepening ulcer causes an 
inflammatory deposit at the site of the threatening perforation; and this 
deposit forms a close adhesion between the peritoneum and the ulcerous spot. 
These adhesions are the natural means of protection for the peritoneum. 

The following types of intestinal ulcers may be distinguished: (i) 
Tuberculous ulcers, which form part of the pathological process described 
under intestinal tuberculosis (which see); (2) typhoid ulcers; (3) dysenteric 
ulcers, which are usually found in the large intestine, whereas the two 
former types are met with almost exclusively in the small intestine; (4) 
syphilitic ulcers; (5) gonorrheal ulcers, which are produced by a transmis¬ 
sion of gonococci from the genitals; (6) carcinomatous ulcers, due to the 
disintegration of cancerous growths; and (7) ulcers resulting from urinary 
intoxication in the presence of chronic inflammation of the kidneys. Syph¬ 
ilitic and gonorrheal ulcers usually develop in the rectum. All these ulcers, 
particularly the syphilitic and the gonorrheal forms, have a tendency to 
produce a cicatricial contraction of the lumen of the gut. They also keep 
up, for weeks and months, a purulent, blood-mixed discharge which greatly 
weakens the patient. Very often there is present also a chronic diarrhea. 







3 Y 3 3HT 30 SW0IT0333A SU0I3AV 0WIW0H2_.IIX 3 TAJ 3 

bibys no x J 2 X ybocf ngia-roi gniioajab j 0 borbaM 

(iimorfoj^) abivbonntnoo -isIi/nmO sviJonntnoo nr (Jaub-Isoo) 

(noisfilsrio) \t2 .3 (jsimljsrflriqnd) a^a-xO 

(b-riupa) zumzidjsilz bsmaini Jdgifl .d 


PLATE XII. —SHOWING VARIOUS AFFECTIONS OF THE EYE 

1. Method of detecting foreign body 3. Sty on eyelid 

(coal-dust) in conjunctiva 4. Granular conjunctivitis (trachoma) 

2. Ox-eye (buphthalmia) 5. Sty (chalazion) 

6. Right internal strabismus (squint) 


Plate XII 



Fief .6 








485 


THE STANDARD FAMILY PHYSICIAN 


Intestines 

Iodin 


In typhoid the small intestine may present from ten to twenty or thirty 
ulcers in various stages of development. In each case the symptoms vary 
with the cause and variety of the intestinal ulcers present. Either suppu¬ 
ration, hemorrhage, or diarrhea may be the most prominent symptom; or 
these symptoms may be combined in various ways. Sometimes the abdo¬ 
men is tender and painful to the touch. If intestinal occlusion be present 
in addition to the ulcers, the symptoms of this condition are superadded. 

From what has been said in the foregoing, it is very evident that no one 
set of rules can be formulated for the treatment of intestinal ulcers. The 
physician must be governed entirely by the circumstances associated with 
each particular case. Some of these ulcerations, for example those found 
in typhoid, may heal without leaving any trace of their existence; but the 
majority either fail to heal, or do so with the formation of scars. The 
original disease which caused the formation of the ulcers often results 
fatally, as in tuberculosis or cancer. In these cases the ulcers remain 
unchanged until the termination of the disease. 

INTOXICATION. — See Alcoholism. 

INTUSSUSCEPTION. — See Intestines, Diseases of. 

IODIN.— A non-metallic element obtained from the ashes of seaweeds. 
When prepared it exists as bright lustrous scales, purplish, grayish-black, 
or bluish-black in color, sparingly soluble in water with the formation of a 
dark yellow or brownish-yellow solution. Iodin is an important constituent 
of the human body, being found throughout the tissues, but more particu¬ 
larly in certain glands, notably the thyroid gland, where it is combined with 
a peculiar albuminous substance ( iodothyrin ) which is thought to be respon¬ 
sible for the characteristic action of the gland. Iodin is very widely used in 
medicine for a vast variety of purposes. Its solution in alcohol, termed the 
tincture of iodin, is an active antiseptic and counter-irritant, being painted 
on sprains and dislocations, and used in a weak solution as a wash for 
infected or foul wounds. In the form of potassium iodid it is widely em¬ 
ployed internally as an alterative, particularly in the treatment of syphilis, 
in chronic rheumatism, and in chronic conditions of glandular swellings, 
and degeneration of blood-vessels. It is, furthermore, used to relieve 
spasmodic affections in a number of the hollow organs, notably in spasms 
of the bronchi (causing asthma), and in disturbances of the bladder. It 
has a wide range of applicability also in a number of chronic pains. The 
use of iodin for a protracted time leads to gastro-intestinal irritation, to the 
formation of pimples and eruptions in different parts of the body, to various 
other skin-disturbances, and to swollen gums, fetid breath, and a form of 
poisoning known as chronic iodism. The withdrawal of the remedy natu¬ 
rally brings about an alleviation of all symptoms. Within recent years a 
large number of iodin preparations have been placed on the market, most 
of which are antiseptic in their action. 






Iodoform 

Itching- 


THE STANDARD FAMILY PHYSICIAN 


486 


IODOFORM.—A combination of iodin and a hydrocarbon, being a 
substance analogous in chemical composition to chloroform, but in which 
iodin is used instead of chlorin. It is a bright yellow powder with a very 
peculiar odor, very disagreeable to most people. It was once extensively 
used as an antiseptic dressing for ulcers, but has fallen into a certain amount 
of disfavor because of the objectionable odor, and because equally effective 
iodin preparations have been made which do not possess this drawback. 
Iodoform used in large doses, even locally, may be followed by poisoning, 
and it should therefore be ordered only by a physician who will watch its 
action carefully. 

IPECACUANHA (IPECAC).—The root of the Cephaelis I pecacuanha, 
a shrub growing in Brazil. It contains two similar alkaloids called emetin 
and cephalaelin. Ipecac is a local irritant. Taken internally it provokes 
vomiting, both by its irritating effect on the stomach and by its action on 
the nerve-center governing the movements of vomiting. It increases the 
flow of saliva and the secretion of mucus in the bronchial tubes. It is used 
in medicine as an emetic for an overloaded stomach, or when it is desired 
to get the relaxing effect of vomiting, as in spasmodic croup. Small doses 
will often stop vomiting when it is not due to irritation of the stomach. 
Ipecac is a very valuable remedy in tropical dysentery. It is useful in the 
early stages of bronchitis, and is often given with opium, in the form of 
Dover’s powder, to break up a cold. The wine of ipecac is given in half 
teaspoonful doses, or three or four times that amount if the emetic action is 
desired. 

IRIS.—The rhizome and rootlets of the Blue Flag, or Iris versicolor. It 
is a purgative which is occasionally given in combination with other drugs. 
The dose of the extract is two to four grains. 

IRIS, INFLAMMATION OF.— See Eye, Diseases of. 

IRON.—Iron as a metal is not used in medicine, but in the form of many 
of its soluble salts it has a very wide application. Iron serves a very im¬ 
portant physiological function in the human body, being the active agent 
in the exchange of oxygen which takes place between the tissues and the 
air. It is found throughout the entire body, but is chiefly located in the 
hemoglobin of the blood. If for any reason the quantity of hemoglobin in 
the blood is diminished, a condition of anemia results. This condition may 
be primary, that is, due to disease of the blood-making organs; or it may 
be secondary, i. e., due to detrimental influences, acting on the entire nutri¬ 
tion of the body, and particularly on the blood. A full description of these 
conditions will be found in the article on Anemia. Iron is of particular 
service in the treatment of secondary anemias, but of less value in the 
primary anemias. It is thought that iron, on being taken into the body, is 
changed in the stomach into the form of a chlorid of iron, and then modified 
into an albuminate. It is taken up by the epithelium-cells of the duodenum, 






487 


THE STANDARD FAMILY PHYSICIAN 


Iodoform 

Itching 


enters into the portal circulation, and is stored up in the spleen, liver, and 
mesenteric lymph-nodes, from which places it is supplied to the rest of the 
body through the medium of the blood. The chief organ for the collection 
of iron is the liver; and this organ serves not only to store up the iron, but 
also to break it down, for large quantities of broken-down blood-pigment 
are found in the bile. 

A number of iron preparations are very active astringents, and are used 
locally to stop bleeding and to prevent mucous discharges. The majority 
of the iron salts are used as indicated in the treatment of altered conditions 
of the blood. Many of the iron preparations, when taken internally, tend 
to produce constipation; and many of the soluble preparations, particu¬ 
larly the chlorid, are apt to stain the teeth when brought into contact with 
them. Iron, no matter in what form it is taken into the body, if able to be 
converted at all, can be utilized. The so-called organic irons are no more 
efficacious than the inorganic. 

ITCH, THE.— See Scabies. 

ITCHING. —This condition may be caused by various harmful agencies 
affecting the skin. Among the most frequent causes are various kinds of 
vermin (fleas, bedbugs, lice, etc.). Not only those places itch which are 
stung by these insects, but even remote parts may be affected. Spiders and 
hairy caterpillars, crawling over the skin, may give rise to similar sensa¬ 
tions. Itching occurs also in a number of internal affections; and it is a 
regular symptom in many skin eruptions, as eczema, nettle-rash, etc. 

In a few skin-diseases proper, the affection is a tormenting one, and can 
be relieved only by scratching. In one of these, called prurigo , the itching 
may begin in the first year of life. An eruption of red spots and small 
pimples, which are scratched, open immediately after they appear. This 
affection may persist throughout life, with occasional improvements during 
the summer months. The eruption is located principally on the front 
surfaces of the legs and on the outer surfaces of the arms, the inner surfaces 
remaining unaffected. Continued scratching causes the skin to become 
dry, thick, hard, of a brown discoloration, and covered with crusts. Owing 
to the constant irritation it frequently happens that eczema is superadded. 
This causes a crust to form, and increases the itching and the other symp¬ 
toms. Frequent bathing, and rubbing with simple ointment, give slight 
relief. 

A second variety of itching of the skin may be present without the pim¬ 
ples. It shows a similar location. Itching occurs spontaneously in differ¬ 
ent parts of the body, at first as a slight tickling sensation, which soon is 
intensified to such a degree that the unfortunate patient rubs the affected 
parts with his garments; often, regardless of his surroundings, he may 
uncover his body to scratch himself with his nails. This nervous itching 
becomes especially obnoxious when it affects the genitals and the anus. 





Jaborandi 

Jigger 


THE STANDARD FAMILY PHYSICIAN 


488 


Here the skin becomes red and thick in consequence of the scratching; 
eczema sets in; and a mucous secretion takes place from the rectum and 
from the vagina. Parts of the skin affected by itching become darker in 
color, and filled with bloody spots. These cases are best treated by a phy¬ 
sician. Some alleviation may be obtained by the use of cool compresses 
and baths, and by washing the parts with vinegar and water, diluted alcohol, 
or spirits of peppermint. In this affection it is important to consult a phy¬ 
sician at the earliest possible moment, as the itching may be a symptom of 
an internal disease (for instance, of the stomach, intestines, liver, or kid¬ 
neys, or of the female genital organs). Many cases are due to the itch. 
See Scabies. 


J 

JABORANDI.—See Pilocarpus. 

JALAP.—The tuberous root of the Ipomoea purga, a vine growing in 
Mexico. Its active principle is a resin known as convolvulin, which is not 
unlike scammony. Jalap is a laxative producing a large watery stool. An 
overdose will cause violent vomiting and purging. It is usually given in 
combination with other drugs. Compound jalap powder contains thirty- 
five parts of jalap and sixty-five parts of cream of tartar. This is frequently 
used in the treatment of dropsy. The dose is from five to thirty grains. 

JAUNDICE .—A morbid condition manifesting itself by yellowness of 
the external skin, the conjunctivae of the eyes, and of the fluids and tissues. 
Jaundice is not an independent disease, but merely a symptom of other 
affections, either of the liver or of some other organ. When the bile is pre¬ 
vented from flowing into the intestine it becomes absorbed into the blood, 
through which medium the bile-pigment is circulated throughout the tissues, 
giving rise to the yellow color. The bile not being discharged through the 
intestine as usual, the excrements become clay-colored; whereas the urine 
discharging the bile-pigment accumulated in the blood becomes dark in 
color, like porter. A very troublesome itching of the skin is almost inva¬ 
riably present. Vomiting, nausea, diarrhea or constipation, loss of appe¬ 
tite, an offensive taste in the mouth, flatulence, belching, and pains in the 
region of the stomach may. also be accompanying symptoms. Jaundice is 
caused by affections of the biliary passages, such as catarrh or gall-stones; 
by narrowing of the bile-ducts in consequence of pressure exerted upon 
them by tumors, accumulated excrements, or far-advanced pregnancy; or 
by affections of the liver. It may be induced also by diseases of the heart, 
of the blood-vessels, or of the nerves; by mental emotions; by poisoning; 
by puerperal fever; and by infectious diseases, such as typhoid fever, 
erysipelas, pneumonia, etc. What is commonly designated as simple jaun¬ 
dice, however, is usually the result following an inflammation (catarrh) of 





489 


THE STANDARD FAMILY PHYSICIAN 


J aborandi 
Jigger 


% 

the mucous membrane of the intestine or of the bile-ducts. Jaundice is 
occasionally observed to occur almost simultaneously in a great number of 
people; as, for instance, in soldiers or in prisoners. In such cases one may 
speak of an epidemic of the disease. 

Jaundice is frequently present in the new-born, or it may develop during 
the first days after birth. The course of this affection is mostly a favorable 
one. The infants enjoy a good appetite, the stools are unchanged, and the 
yellow color of the skin usually disappears inside of two weeks. It is only 
in exceptional cases that jaundice endangers the life of the infant; and in 
such cases it is probably associated with affections of the navel. 

Jaundice of adults sometimes disappears after a few days, but at other 
times it may persist for months or even for years. If the symptom prevails 
for more than four to eight weeks, or if it should increase in severity, a serious 
disease is sure to be the true cause of the condition. Nevertheless, it may 
still terminate favorably. The first manifestation of recovery consists in a 
yellowish color of the stools. Then the urine also regains its normal appear¬ 
ance. If recovery does not take place, jaundice often results in death, 
although it has happened that convalescence has set in after the affection 
had existed for several years. 

The treatment of jaundice is either medicinal or dietetic, although it may 
often be necessary to combine both methods. Only a physician is able to 
decide whether an attack of jaundice is due to a slight gastro-intestinal 
derangement, or whether a serious disease endangering the life of the 
patient is at the bottom of the condition. It is necessary, therefore, always 
to have recourse to medical assistance. Existing catarrhs of the stomach 
require a strict diet consisting of toast, zwieback, bland soups, vegetables, 
and stewed fruits; later, eggs and lean meat may be added. Fatty foods 
must be strictly avoided. Intestinal catarrhs likewise demand dietary 
treatment, and in addition to this the stools must be carefully regulated; 
this may often be accomplished by water enemas. Mineral waters (selters, 
vichy, etc.) are useful. The tormenting itching of the skin may be alleviated 
by washing with cold water to which citric acid (lemon juice) or vinegar has 
been added; or by warm baths with the addition of soda. Obstinate attacks 
of jaundice may require the use of special mineral waters from European or 
American spas. In many instances jaundice is due to gall-stones, in which 

cases the patients require surgical help. 

JAW, DISLOCATION OF. —This may be brought about by opening the 
mouth overwide, as in yawning, or by accidental blows 01 falls. The pa- 
tient’s mouth remains wide open, and the saliva flows out without hmdiancc. 
It is usually easy for a physician to effect a reduction; but it is not advisable 
to try the popular method of doing this by striking the chin. Individuals 
in whom dislocation of the jaw is apt to recur should avoid excessive yawning. 

JIGGER.— See Sand-Flea. 






Joints 

Juniper 


THE STANDARD FAMILY PHYSICIAN 


490 


JOINTS. —For anatomy and functions, see Introductory Chapters 
(pp. 38-41). 

JOINTS, DISEASES OF. —Affections of the joints are very common. 
Dislocations are of frequent occurrence, while simple swelling as a result 
of injury is an every-day event. Chronic joint-affections are usually tuber¬ 
culous in nature. Only a few of the more important joint troubles are here 
considered. 

Effusion of Fluid. —An accumulation of fluid may take place in a joint 
in consequence of inflammation (see the paragraphs following). 

Inflammation. —This is usually a very serious affection, the more serious 
the larger the joint involved. The seriousness is due to the fact that the 
function of the affected joint may become impaired, and that even stiffness, 
with its attendant disability, is liable to set in. In some cases the affected 
joint, instead of becoming stiff, becomes too movable (shaky), so that it is 
necessary to apply supporting apparatus in order to render the joint fit for 
some use. Some diseases of the joints cause severe destructions, so that it 
eventually becomes necessary to remove the affected bones of the joint. 
The severest cases may even necessitate amputation in order to preserve 
the life of the patient. It is obvious, therefore, that in cases of inflamma¬ 
tions of joints, it is of the utmost importance to call a physician as early as 
possible. Nor should the patient lose courage and hope even if recovery 
or improvement be long delayed. Inflammations of joints are protracted 
affections which often require months, or even years, to be cured. 

Not all cases are uniformly severe. In the first place the nature of the 
effusion which accumulates in the affected joint must be considered. If 
the effusion be a watery one, the affection, as a rule, is not very serious. The 
joint becomes swollen, but not red and hot. The disease is more danger¬ 
ous, however, if a purulent effusion develops. The patient is then usually 
feverish, and can move the joint only with great pain. It is swollen, and 
the skin covering it is red and hot; frequently the swelling has a doughy 
consistency on pressure. 

The cause of the inflammation is of the utmost importance. Certain 
diseases, especially tuberculosis, syphilis, acute rheumatism, and gonorrhea, 
give rise to very severe inflammations. Many inflammations which run a 
slow course are due to tuberculosis which originates either in the bone or in 
the membrane of the joint, and which may cause extensive destructions in 
the joint. Inflammations of the hip-joints and knee-joints in children are 
often tuberculous in nature, and are distinguished by a particularly pro¬ 
tracted course. Naturally, the treatment of the various forms of inflam¬ 
mation of joints is quite varied. Massage and medico-mechanical treat¬ 
ment are indicated in some instances; whereas absolute rest of the joint in 
an appropriate bandage may be in order in other cases. In many cases, 
especially in the purulent ones, immediate operation is necessary in order 





491 


THE STANDARD FAMILY PHYSICIAN 


Joints 

Juniper 


to drain the pus. Others may require surgical interference only in the 
course of time; and this is especially the case in tuberculous inflammations. 
It follows, therefore, that only a physician or a surgeon who is familiar with 
the different forms of the disease, and with their proper treatment, is able to 
take the steps necessary to benefit the patient. 

Swelling. —In the preceding paragraphs it has been emphasized that 
inflammation of a joint is a frequent cause of swelling. Other common 
causes are injuries, such as blows, contusions, or sprains. Articular rheu¬ 
matism (acute as well as chronic) may likewise give rise to swellings of the 
joints. When the swelling is the result of an injury it is caused by an 
extravasation of blood, which is located either in the soft parts covering the 
joint, or in the joint-cavity. If located in the joint-cavity the extravasation 
may be removed by massage, or, if this proves ineffectual, by a slight opera¬ 
tion consisting in introducing a hollow needle into the joint, thus draining 
the blood. After the operation it is necessary to cover the joint with a 
bandage, and to keep it at rest. Many swellings located at a joint do not 
involve the joint itself, but are swellings of the mucous pouches (bursa 
mucosa) which are situated over the joints. Such swellings of the bursae 
occur especially at the joints of the shoulders, knees, and wrists. In simple 
swellings due to injury, such as spraining the ankle, etc., hot-water appli¬ 
cations afford much relief. They may be applied by means of hot cloths 
or by the use of hot-water bottles. 

Joint-Mouse (Floating Cartilage). —Term used to designate a small 
piece of bone or cartilage which, owing to inflammatory processes in a 
joint, has become separated so that it is freely movable within the joint- 
cavity. It may consist also of an inflammatory growth which has become 
detached from the joint-membrane. The most disagreeable manifestation 
of the presence of such a joint-mouse occurs when it becomes wedged 
between the bones of the joint, causing violent pain. Usually, in such 
cases, the joint can not be moved, but remains fixed in a certain position. 
Many patients soon learn to execute certain movements which cause 
the joint-mouse to spring back into the joint-cavity, thus bringing about the 
former movability. The frequent wedging of the joint-mouse between the 
bones of the joint gives rise to considerable irritation which may cause a 
watery effusion to form; and this, in the course of time, will lead to a loosen¬ 
ing and relaxation of the joint. This condition, which is very disagreeable, 
most frequently affects the knee-joint, greatly impairing the ability to walk. 
The only successful treatment consists in removing the joint-mouse. Owing 
to the progress made in the treatment of wounds this is not a dangerous 
operation; but it should be performed only by a practical surgeon. 

JUNIPER. —The fruit of an evergreen tree, the Juniper us communis. 
It contains a volatile oil, and a resinous compound called juniperin. Juni¬ 
per is a stimulant to the kidneys, increasing the flow of urine. It is too irri- 




Kamala 

Kidneys 


THE STANDARD FAMILY PHYSICIAN 


492 


tating to be used if there is any active inflammation of the kidneys; but in 
chronic conditions, or in simple congestion, it is very useful as a mild diu¬ 
retic. Gin contains a certain amount of juniper. The spirits of juniper 
may be given in teaspoonful doses. 


K 

KAMALA. —A reddish-brown powder composed of the glands and hairs 
from the capsules of an Oriental plant, the Mallotus Philippinensis. It 
contains two substances, kamalin and rottlerin , but it is not known which 
of these is the more active principle. Kamala is used as a remedy for tape¬ 
worm and roundworm. Being an active purgative it is not necessary to fol¬ 
low it with any laxative. The dose is a teaspoonful, and it is often combined 
with hyoscyamus to prevent griping. 

KAOLIN.— This is a porcelain-clay, chemically known as aluminum 
silicate. It is a soft, whitish powder which is insoluble in water and quite 
inert chemically. For this reason it is used as a basis for pills of easily 
reducible substances, such as silver nitrate, which would be altered imme¬ 
diately if mixed with any of the vegetable powders. Clay is also widely 
employed as a basis for ointments; and when impregnated with antiseptic 
substances it makes a clean and efficient antiseptic dressing for infected 
wounds, such as cuts, ulcers, etc. 

KEPHIR AND KUMISS. —Beverages which have been introduced into 
western countries from the Asiatic domains of Russia, as remedies for con¬ 
sumption. They have been designated as milk-wines, because they are 
prepared by fermentation. In their native countries they are prepared 

from mare’s milk; in western countries, from 
cow’s milk. The method of making kephir is 
the more simple one for domestic use, as it is 
sufficient to add to one pint of milk a table¬ 
spoonful of kephir granules (which may be ob¬ 
tained in some drug-stores), and to leave this 
mixture, which must be frequently shaken, 
from one to three days in a moderately cool 
place. It should be prepared in a strong bot¬ 
tle with a close-fitting, patent stopper (see Fig. 
246). Kumiss, on the other hand, is best made 
by a qualified manufacturer. If it be desired 
to make it at home, reliable formulas may be 
found in most cook-books, but the purchased 
article is to be preferred. In the United States 
it is made from milk and yeast. The more nu¬ 
trient constituents of the milk are preserved, and 



Fig. 246. Bottle in which to 
prepare kephir. 











493 


THE STANDARD FAMILY PHYSICIAN 


Kamala 

Kidneys 


the sugar is converted into carbon dioxid gas and lactic acid, rendering the 
beverage sparkling, and giving it a mildly acid taste much liked by some 
people. 

Kephir and kumiss are valuable in the treatment of anemia, consump¬ 
tion, scrofula, persistent constipation, intestinal catarrhs, and scurvy. 
Neither of these beverages, however, should be taken unless the patient’s 
kidneys and stomach are healthy. At the beginning one bottle a day should 
be taken, gradually increasing to three bottles of kephir a day, and more of 
kumiss. 

KIDNEYS. —For structure and functions, see Introductory Chap¬ 
ters (p. 59). 

KIDNEYS, DISEASES OF. —The kidneys being organs of very complex 
structure, it is natural that they may become diseased in various ways. 
Only the more important affections of these organs are here discussed. 

Bright’s Disease. —Inflammation of the urinary tubes, causing degen¬ 
eration of the kidneys. This affection has been so named after an English 
physician, Richard Bright, who first described it (1827). The disease may 
be either acute or chronic. The acute form occurs as a complication in 
many infectious diseases, such as diphtheria, measles, smallpox, typhoid 
fever, pneumonia, malaria, and pyemic and septic fevers (especially scarla¬ 
tina) ; and also after severe exposure and colds. It may be brought about 
also by dwelling in cold and damp rooms, and by poisoning with acids, 
highly irritating ethereal oils, cantharides, etc. The onset of the affection 
is usually characterized by changes in the urine and in the general health. 
The disease appears either suddenly, with fever, violent chills, vomiting, 
difficulty in passing the urine, and pains in the regions of the kidneys; or 
it sets in very gradually, with weakness, severe headache, nausea, marked 
pallor, and with symptoms of dropsy in the face, the hands, and the feet. 
The urine, which is passed in small quantities, contains much albumin, and 
is pale red to brownish-red in color; on standing it deposits a sediment 
which contains a great deal of blood. 

The chronic form of the disease may be the result of an acute attack of 
the affection; but generally it develops slowly and insidiously. All the 
causes mentioned under the acute form may be factors also in bringing 
about the chronic type. It is most frequently incurred by repeated expo¬ 
sure to cold or drenching, by dwelling in cold and damp rooms, by the con¬ 
stant ingestion of food which irritates the kidneys (spices, for instance), 
by the abuse of alcohol, and by long-lasting suppuration, pulmonary tuber¬ 
culosis, and syphilis. The course of the disease is often concealed under the 
symptoms of catarrh of the stomach, pallor and anemia, severe headache, 
shortness of breath, and general weakness; or it may manifest itself by the 
development of Dropsy, and Uremia (which see), and by palpitation, 
enlargement, and weakness of the heart. Only expert chemical and micro- 




Kidneys 


THE STANDARD FAMILY PHYSICIAN 


494 


scopical examination of the urine will lead to correct diagnosis of the 
affection. Chronic Bright’s disease may terminate in recovery in a year 
or two; but some patients may have the disease for twenty years, or even 
longer. The prospects of cure are favorable with appropriate treatment, 
but are greatly impaired by neglect and by the supervention of serious 
complications. 

In order to prevent attacks of Bright’s disease, careful regulation of the 
general mode of living is of great importance. Bodily overexertion, con¬ 
stant dwelling in cold and damp houses, and repeated exposure to rain and 
cold, may be harmful in this as well as in other respects. Occupations 
which expose the body to cold and wetting should be avoided. After a 
drenching it is important to remove the wet clothing as soon as possible, to 
rub the body with warm and dry towels, and to put on dry garments. The 
general mode of living, and the use of stimulating foods greatly influence 
the activity of the kidneys. From early youth the body should be hardened 
by cold ablutions and regular exercise; and scrupulous cleanliness should 
be observed. These precautionary measures are of great value in enhan¬ 
cing the resistance of the body, because of their stimulating action upon the 
vital functions. Excessive eating, the inordinate and continued use of 
meat diets and of strong spices, and the excessive drinking of alcoholic 
beverages, coffee, and tea, cause marked irritation of the kidneys, and may 
give rise to chronic inflammation. Even a single excess may be followed 
by injurious consequences. 

Owing to the intimate relations existing between the urinary and the 
genital apparatus, affections of the latter demand the immediate and most 
careful medical treatment in order that harmful reactions upon bladder 
and kidneys may be avoided. Care should be taken never to retain the 
urine for any great length of time. One should always yield to the call of 
nature at once, without being influenced by social regards and misguided 
modesty. Forcible retention of urine may be followed by very disagreeable 
consequences. In cases where catheterization is necessary, as in narrowing 
of the urethra, enlargement of the prostate gland, and inflammations of the 
bladder, it is of great importance to observe the utmost caution and the 
most scrupulous cleanliness, especially if the patient himself attends to 
the catheterization (see Catheterism). In order to prevent changes in 
the position of the kidneys from taking place, women should avoid too early 
rising after childbed, especially when the abdominal wall is abnormally re¬ 
laxed, as after repeated childbirths. Tight waist-bands and corsets should 
likewise be avoided at such times. 

In the treatment of all kidney-diseases (or in cases where it is suspected 
that such a disease may be present), an examination of the urine is abso¬ 
lutely necessary. A microscopical examination of the urine and an inter¬ 
pretation of the findings should be undertaken only by a scientifically 




495 


THE STANDARD FAMILY PHYSICIAN 


Kidneys 


trained physician, as it is possible to do this only upon the basis of an accurate 
knowledge of the conditions of the urinary secretions in health and in dis¬ 
ease. If a correct diagnosis of an affection of the kidneys has in this manner 
been made by a medical practitioner, it is necessary, above all, to care for 
the affected organs. This not only requires bodily and mental rest, but also 
a careful regulation of the diet. In addition to the directions given by the 
physician in each individual case, a warm bath (86° to 96° F.) may be taken 
every half hour or hour, with subsequent wrapping of the entire body in 
woolen blankets. Such baths stimulate and facilitate the excretion of the 
water detained by the diseased kidneys, as well as of the dissolved urinary 
constituents. In recent cases of chronic Bright’s disease a prolonged 
sojourn in a warm climate, with absolute rest and a careful diet, is often 
followed by remarkably good results. 

Cancer of the Kidneys.—This affection occurs most frequently in indi¬ 
viduals well advanced in years, although it may occur also in middle-aged 
persons. The first manifestation of the disease may consist only of pains 
in the region of the loins. These are later followed by the development of 
a painful, immovable tumor which can be felt through the abdominal wall, 
and which may even bulge out in the lateral part of the abdomen. The 
pressure of this tumor may cause pain located in the abdominal wall, 
and this pain may radiate forward into the genital organs or into the thighs. 
This symptom is not infrequently accompanied with the excretion of urine 
containing blood. The general health of the patient also suffers from the 
growth of this malignant tumor. Pallor of the skin and of the mucous 
membranes, loss of appetite, emaciation, and decline of strength characterize 
the pernicious effects of renal cancer in an advanced stage of the disease. 
The patient’s life can be saved only by operation which must be performed 
after an early recognition of the affection. 

Congestion of the Kidneys.—Engorgement or congestion of the kidneys 
may occur temporarily after a cold bath, drenching, bodily overexertion, 
forced marching, etc.; or it may be a permanent condition as a symptom of 
certain disturbances of the circulation in affections of the heart-muscle or 
of its valves, in severe cases of calcification of the veins or arteries, or in 
certain lung-affections. When it occurs as a symptom of circulatory dis¬ 
turbances, severe manifestations are usually present. There may be slight 
bluish discoloration of the face, congestion of the lungs (resulting in short¬ 
ness of breath, and in violent cough with the discharge of whitish-red 
sputum), swelling of the liver, and swollen feet and hands. In these affec¬ 
tions the blood is congested in the kidneys, causing an impairment of their 
urine-secreting functions, and as a result of this the discharge of urine is 
but scanty. The urine is usually dark red, and thick; and upon standing 
it may form a conspicuous brick-red sediment. It should, however, be 
remembered that all urines, even that of an absolutely healthy individual, 




Kidneys 


THE STANDARD FAMILY PHYSICIAN 


496 


will show a brick-dust deposit upon standing for any length of time in a 
cold room. Usually the urine contains small quantities of albumin, rarely 
of blood. 

These secondary congestions require treatment of the underlying dis¬ 
ease. Primary congestions due to exposure or cold, or to the effects of irri¬ 
tating poisons (chloroform, ether, phosphorus, etc.), should be treated with 
great care. Rest in bed, warm applications to the loins, and a restricted 
liquid diet are the essentials. 

Contraction of the Kidneys.—This affection is characterized by its 
exceedingly slow and chronic course, and by the excretion of large quantities 
of light, slightly albuminous, and somewhat cloudy urine. As much as three 
to four quarts may be passed in one day. Dropsy is usually entirely absent; 
but the condition may frequently be accompanied by uremia, and by all 
the other disturbances described under chronic Bright's Disease. Cerebral 
hemorrhages are not rare in connection with contracted kidneys. Among 
the causes which give rise to the affection may be mentioned calcification of 
veins and arteries, gout, lead-poisoning, and syphilis. 

Dropsy of the Kidneys (Hydronephrosis).—An affection which occurs 
principally in women, and which may involve either of the kidneys. It is 
characterized by an accumulation of urine above the point of an obstruction 
brought about by an impediment in the ureter or in the bladder, thereby 
leading to a dilatation of the affected part and, finally, to a pouch-like dis¬ 
tention of the pelvis of the kidney. Large tumors may develop in this 
manner, often containing several quarts of urine. The damming of the 
urine, and the consequent pressure upon the kidney, may eventually lead to 
an impairment of the secreting functions of the organ; in some cases it may 
even lead to degeneration, or to complete wasting, of the kidney-tissue. 

The disease may result from twisting or bending of the ureter in floating 
kidney; or it may follow an obstruction of the ureter by a stone, or com¬ 
pression of the ureter by a tumor. It may be due to an antecedent inflam¬ 
mation of the pelvis of the kidney, to displacement of the womb, or to 
narrowing of the urethra. The chief symptoms consist in sudden vomit¬ 
ing, headache, sensations of pressure and pain in the region of the affected 
kidney, diminution in the amount of urine voided, and the formation of a 
swelling in the side of the abdomen. Pressure or change of position may 
lead to a sudden decrease in the size of this swelling, accompanied with pro¬ 
fuse discharge of urine. Treatment can be carried out only after the cause 
of the affection has been accurately determined. Surgical treatment offers 
the only cure. 

Floating Kidneys.—The kidneys, like all other abdominal organs, are 
fastened in their position in the abdomen. If a kidney break loose from 
its anchorage it tends to sink; it changes its position constantly, according 
to the position of the patient, and thus gives rise to many symptoms of 






497 


THE STANDARD FAMILY PHYSICIAN 


Kidneys 


disease. Floating kidney is seen very frequently in women between the 
ages of twenty-five and forty-five, mostly affecting the right side. It is 
caused by the disappearance of the fat which surrounds the kidney and holds 
it in place. This condition arises in connection with all wasting diseases, 
with rapid emaciation, or from relaxation of the abdominal musculature. 
The last-named cause may result from repeated childbirths, from getting up 
too soon after confinement, from the tension exerted by the intestines upon 
the suspensory ligaments of the kidney, or from disease or change of position 
of the female sexual organs. Other frequent causes are tight lacing, severe 
physical labor, and the lifting of heavy objects. 

In many cases floating kidney gives rise to only slight symptoms, or to 
no symptoms at all; in others, very unpleasant conditions ensue. As a rule 
the patient complains of nervousness, general uneasiness, frequent malaise, 
heaviness, and of pressure and slight pain in the abdomen. Walking and 
severe physical exercise (riding, dancing, etc.) may greatly aggravate the 
condition. Among other complaints which frequently accompany the 
affection may be mentioned attacks of nervous pains in the lumbar region 
or between the ribs, severe headache, disturbances of the stomach and intes¬ 
tine, and especially constipation. A sudden change of position with torsion 
of the body will cause severe colicky pains in the stomach, accompanied by 
chills, vomiting, sensations of fear, retention of urine, and, in rare cases, by 
dropsy of the kidney. 

Floating kidney is not a dangerous affection. The annoying symptoms 
generally subside in a very short time if the kidney can be replaced in its 
normal position and kept there. When symptoms of incarceration are 
present, the replacing of the kidney must be undertaken only by a physician. 
Elastic bandages, corsets, etc., for holding the kidney in position, should 
always be selected by a specialist, and not by a belt-maker. Very good 
results are obtained from a course of forced feeding, massage of the kidney, 
and methodical water-treatment. In severe cases it may be necessary to 
perform an operation by which the kidney is securely sutured into its proper 
position. 

Inflammation of the Pelvis of the Kidney.—Acute and insidious inflam¬ 
mation of the kidney-pelvis may arise in consequence of the entrance of 
pathogenic germs, which may reach the kidney through the ureter in gon¬ 
orrhea or in inflammation of the bladder, or through the introduction of an 
unclean catheter. A bacterial infection of the kidney-pelvis may be brought 
about also by means of the blood, if the bacteria (as in typhus, scarlet fever, 
puerperal fever, or blood-poisoning) reach the kidney through inflammation 
of the lungs. Other causative factors are suppurative inflammation of the 
kidneys, and the irritation exercised upon the kidney-pelvis by poisons, or 
by granules or stones of the kidney. 

The attack most frequently begins with a gradually increasing pain on 





Kidneys 

Knock-Knee 


THE STANDARD FAMILY PHYSICIAN 


498 


one side, in the vicinity of the kidney. The urine is cloudy; and upon 
standing for some time it forms, without becoming clear itself, a yellowish- 
white deposit which frequently comprises one-third of the total amount of 
urine. This deposit consists of mucus, pus, and blood. When pus is 
present in the pelvis of the kidney, there is high fever with chills, nausea, 
and vomiting. In most cases inflammation of the kidney-pelvis is accom¬ 
panied by some other affection of the kidney. Except in light cases, the 
course of the disease is apt to be prolonged, especially when the kidney 
proper is involved. Nevertheless, the issue is usually favorable; and, 
except where a considerable formation of pus takes place, the disease does 
not endanger life. General measures that are helpful in the treatment of 
this disease include rest in bed, simple food (preferably a milk diet), copious 
drinks of mineral waters, and lukewarm baths. The special treatment for 
each individual case must always be left to the physician. An operation is 
usually necessary. 

Renal Colic.—A condition manifesting itself by sudden attacks of violent 
pain in one side of the abdomen, in the region of the kidney, radiating into 
the abdomen, the small of the back, and into the bladder and sexual organs. 
The attack is ushered in by pain, vomiting, violent chills, rise of temperature, 
and marked difficulty of urination. In spite of an urgent desire to urinate, 
only a few drops may be passed. Renal colic is accompanied by cold per¬ 
spiration, spasms, and attacks of fainting. The paroxysm usually persists 
for several hours, and is followed by a feeling of depression and exhaustion 
lasting for some time; but in some cases the tormenting condition may be 
protracted for several days. Single attacks are comparatively rare, recur¬ 
rences being the rule; but these usually terminate favorably. The disease 
occurs mostly as a consequence of the formation of gravel or kidney-stones; 
more rarely as a result of the presence of worms in the pelvis of the kidney. 
The attack is due to the attempted passage of a stone into the bladder 
through the ureter. The pain may cease as a result of the successful voyage 
of a stone, or as a result of its slipping back into the pelvis of the kidney. 
Other causes of renal colic are the sudden bending or twisting of the ureter 
in floating kidney, spasm, scar formation in the ureter, compression of the 
ureter by tumors, displacement of the womb, etc. The attacks of pain 
require immediate medical attention, but until the physician’s arrival con¬ 
siderable relief may be obtained by applying hot compresses to the abdomen 
and loins, and also by taking warm baths. 

Stones, Gravel, and Sand in the Kidneys.—Smaller or larger structures 
may form in the pelvis of the kidneys or in the ureters, resulting from the 
deposit of stone-forming masses (salts) around a nucleus which usually 
consists of mucus, pus, tumor-particles, or coagulated blood. The affection 
may occur at any time of life. It is, however, most frequent in middle- 
aged persons, and is usually one-sided. Its course may be without any 







499 


THE STANDARD FAMILY PHYSICIAN 


Kidneys 

Knock-Knee 


disturbances if the deposit is small (sand or gravel) and easily washed out 
through the urinary passages with the urine. Larger stones, however, 
often become caught in the ureter, giving rise to renal colic. Irritation 
of the mucous membrane of the pelvis of the kidney may result in inflam¬ 
mation, suppuration, or ulceration; and complete obstruction of the ureter 
may lead to dropsy of the kidney. Aside from the extremely characteristic 
attacks of renal colic, the affection can be readily recognized from the occur¬ 
rence of sand, gravel, or small stones in the freshly voided urine, which often 
contains mucus, blood, and pus in addition. 

The course of this frequent affection is usually favorable, and becomes 
of grave import only in cases where suppuration and ulceration take place in 
the kidneys or in the ureters. If the stones be uric-acid stones, it is neces¬ 
sary, above all, to regulate the diet and to restrict the ingestion of albumin¬ 
ous foods. Irritating foods and alcoholic beverages must be avoided; and 
vegetable dishes, milk, and farinaceous foods should be preferred. Wash¬ 
ing the renal pelvis, and the expulsion or dissolution of the stones, should be 
accomplished by drinking large quantities of milk, or by taking cures at a 
spa. In Europe , Ems, Wildungen, Salzbrunn, Carlsbad, Marienbad, and 
Franzensbad are the most popular spas. In the United States , Virginia 
Hot Springs, Frenchlick Springs, Saratoga, and Mt. Clemens may be rec¬ 
ommended. The mineral waters of these resorts may be drunk at home. 
Metabolism must be stimulated by regular activity of the muscles, and by 
baths and massage. If the condition gives rise to severe consequences, 
operative removal of the stones may become necessary. It is important to 
remember that a brick-dust deposit in a cold chamber is not a sign of dis¬ 
ease, quack literature to the contrary notwithstanding. Plate XV. shows an 
X-ray photograph of a stone in the kidney. 

KING’S EVIL.—See Scrofula. 

KINO.—The dried juice of an East-Indian tree, the Pterocarpus mar- 
supium. It occurs in small, reddish fragments, with a bitter astringent 
taste. Kino contains kinotannic acid, and its action much resembles that 
of catechu. The dose of the tincture, which is used as an astringent in 
dysentery, diarrhea, leucorrhea, etc., is about a teaspoonful. 

KLEPTOMANIA.—See Mental Diseases. 

KNOCK-KNEE.—A deformity in which the legs form an angle, obtuse 
outwardly, the apex of which lies in the knee-joint (Fig. 247). The disease 
is not only a cosmetic defect, but is the source of many difficulties to the 
possessor. As a rule he can not stand or walk for any length of time, tires 
easily, and is therefore unfit for many callings. Knock-knees develop in 
children in consequence of rickets; in young persons they develop from 
overburdening or overexercising the legs. This is especially the case with 
young persons whose vocations in life demand long standing, causing fatigue, 
such as waiters, blacksmiths, bakers, etc. 






Krameria 

Larynx 


THE STANDARD FAMILY PHYSICIAN 


500 


In the treatment of knock-knees, efforts must be made to remove the cause. 
If resulting from Rickets (which see) in small children, this condition can 

be treated. If resulting from overburdening of the 
legs, measures must be taken against the deleterious 
influence. The developed abnormality may be treated 
in various ways. In young children a cure may be 
effected by applying plaster of Paris bandages to the 
legs after these have been straightened; or by applying 
splints, gradually effecting a correct position of the 
legs. Certain forms of knock-knees demand operative 
interference, either bloodless or otherwise. When the 
operation is bloodless, the leg is adjusted by breaking 
the bone by manual strength or by a machine, allow¬ 
ing it to join in the straightened position. In bloody 
operations, the straightening is achieved by sawing 
through the bones of leg and thigh, and then bringing 
the extremities into the correct position. 

Young persons whose physical structure and strength 
are not adequate for the prolonged standing necessary 
in some callings, ought not to choose the vocations of 

Fig. 247. Knock-knee. t> ’ b 

baker, blacksmith, salesman, waiter, etc. 

KRAMERIA (RATANY). —The root of the Krameria triandra and the 
Krameria ixina, allied shrubs growing in South America. It occurs in the 
market in sticks of from one to two feet in length and from one-fourth to 
one inch in diameter. Krameria is a vegetable astringent containing 
Tannic Acid (which see). The tincture is given in doses up to a tea¬ 
spoonful for its astringent action. It is sometimes made up in troches 
which are useful for relaxed or congested throat. 

KUMISS.—See Kephir and Kumiss. 


L 



LABOR.—See Parturition. 

LACRIMAL GLAND, SAC, AND DUCT, DISEASES OF.—The lacrimal 

gland is a small organ which is situated above the outer corner of the eye 
and which secretes the tears. The lacrimal sac forms the upper, rounded 
eminence of the lacrimal duct which conveys the tears from the inner corner 
of the eye to the nose (see pp. 68-69, an d Fig- 58). Affections of the lac¬ 
rimal gland, such as tumors and suppurations, are rare conditions, and are 
observed only in isolated cases. Diseases of the lacrimal duct are more 
frequent. An obstruction in this canal causes the tears to stagnate and 
decompose, as a result of which bacteria may settle and give rise to puru- 















501 


THE STANDARD FAMILY PHYSICIAN 


Krameria 

Larynx 


lent inflammation of the mucous membrane of the canal. Inflammation of 
the lacrimal sac results in the destruction of its wall, and in the formation 
of a fistula. The bacteria are a great menace to the eye. Where there is 
present a superficial injury of the cornea, bacteria may settle in the wound 
and give rise to a corneal ulcer which may seriously impair the sight, or 
even cause total loss of the eye. For these reasons obstructions in the lacri¬ 
mal ducts should never be neglected, but should at once be removed by a 
physician. 

LACTATION.—See Nursing. 

LANOLIN (ADEPS LANA2 HYDROSUS).—A yellowish substance, of 
the consistency of lard, and obtained by purifying the fat contained in 
sheep’s wool. It has no special properties of its own, but, on account of 
its soothing effect on the skin, it is useful as a basis for salves intended for 
cutaneous application. 

LARYNX.—For anatomy and functions, see Introductory Chapters 
(pp. 49-50). 

LARYNX, DISEASES OF.—The vocal cords and their surrounding 
structures are subject to a large number of affections. Exposure to cold, 
or to the action of irritating gases, may cause simple catarrhal inflamma¬ 
tion which may terminate in early recovery or pass into a chronic condition. 

The affection is often aggravated by excessive smoking (smoker’s sore 
throat), or by prolonged use of the vocal cords, as in teachers, singers, min¬ 
isters, etc. New growths may occur on the vocal cords, or they may become 
the seat of chronic inflammations due to certain micro-organisms, tuber¬ 
culosis, syphilis, etc. Some of the more common affections of the larynx 
are here considered. 

Catarrh of the Larynx (Laryngitis).—This disease may be either acute 
or chronic. The acute form may be due to cold and drenching, to affec¬ 
tions of the nose and of the windpipe (especially if respiration is carried on 
habitually through the mouth), to overexertion of the vocal cords, to 
inhalation of foul and dusty air, etc. Bicyclists are particularly liable 
to contract this disease from inhaling large quantities of dust. The reg¬ 
ular use of strong spices and of alcoholic drinks is a well-known cause of 
laryngeal catarrh. Some diseases, such as influenza, measles, and whooping- 
cough, often involve the larynx. Men are more frequently affected than 
women, owing to the more exposed nature of their occupations. Cases of 
acute catarrh of the larynx occur with greatest frequency during spring and 
autumn; more rarely in summer. 

Acute laryngitis begins with irritation and dryness of the throat, soon 
followed by more or less hoarseness. If the voice be not used to excess, and 
no grave sins committed against the rules of hygiene, the process may pass 
within a week. Severe forms of the disease, however, may lead to super¬ 
ficial ulcers on the vocal cords, or to thickening of the false vocal cords which 





Larynx 


THE STANDARD FAMILY PHYSICIAN 


502 


are located over the true ones (see Fig. 51), and may require weeks to be 
cured. In the dry forms of laryngitis slight hemorrhages may take place. 
Recovery is delayed by smoking, drinking, dancing, much talking, and 
singing; it may even be entirely prevented so that a chronic inflammation 
develops. 

A mild catarrh heals spontaneously if properly cared for. In order to 
assist nature in bringing about recovery it is advisable to remain indoors, 
to abstain from smoking, to speak as little as possible, to take inhalations of 
steam, to drink warm mineral waters with or without milk, and to place a 
cold compress around the neck at night, allowing it to become warm. The 
tendency to cough should be suppressed by soothing medicines. 

In children an acute catarrh of the larynx often manifests itself in the 
form of a croupy cough. The children “bark” suddenly at night with a 
hoarse sound, and suffer from the signs of impaired respiration, which some¬ 
times increases almost to suffocation. Such attacks, which may last an 
hour or two, may recur night after night for one or two weeks in succession. 
In certain cases, however, a recurrence may not take place until a fresh 
cold has been contracted. This disease, which constitutes the so-called 
“false croup,” almost invariably terminates in recovery. Hot drinks may 
be given to loosen the viscid mucus. 

Chronic catarrh of the larynx usually develops from the acute form. 
It is especially frequent in ministers, orators, military officers, minstrels, 
street venders, stone-cutters, tavern-keepers, and workers in tobacco fac¬ 
tories. The disturbances comprise dryness, constant hoarseness, irritation, 
and hacking or coughing. The degree of hoarseness varies. Sometimes 
the voice is entirely absent, especially on awakening in the morning, or after 
severe vocal exertions. If the disease runs a very protracted course it may 
cause paralysis of the vocal muscles and thickening of the cords. 

The course of the affection is the more obstinate the less the patients 
heed the directions of the physician, or the less they are able to do so on ac¬ 
count of their occupations. Acute attacks frequently recur. Above all, 
special attention should be paid to free breathing through the nose. If the 
nose be temporarily or constantly obstructed it should be cleared by a phy¬ 
sician. The domestic remedies commonly used for the acute form of laryn¬ 
gitis aie larely efficacious in the chronic type of the affection. As a rule 
local treatment is required; often of the nose and pharynx also. 

Dropsy of the Larynx. This condition may occur in affections of the 
kidneys, and in purulent inflammation of the throat or of the tonsils. It 

may lead to death by suffocation unless an opening is made by incision 
into the windpipe. 

Foreign Bodies in the Larynx.—Foreign bodies rarely enter the larynx. 
Small, rounded objects (as beads, coins, and buttons) usually pass into the 
windpipe, or remain in the throat. Pointed objects (as fish-bones, pins, 




503 


THE STANDARD FAMILY PHYSICIAN 


Larynx 


and needles) stick to the sides of the trachea, and may lead to considerable 
difficulty of breathing. Their removal by a physician is often difficult, 
although usually possible. By the aid of long tubes it is even feasible to re¬ 
move foreign bodies from the deeper branches of the windpipe, but as a 
rule it is necessary to make an opening by incision into the trachea. It is 
extremely risky to hold pins, nails, or other pointed objects between the lips, 
as they are very liable to pass into the trachea in consequence of a sudden 
cough or laugh. Children should be especially cautioned against doing so. 

Syphilis of the Larynx.—The earliest symptom of syphilis in the larynx 
consists in the formation of mucous patches, or in an attack of very per¬ 
sistent catarrh. At a more advanced stage of the disease the formation of 
gummatous tumors and membranous growths which narrow the laryngeal 
space is the chief manifestation. The character of the disease can be de¬ 
termined only by aid of the laryngoscope, and the only efficacious treatment 
is with mercury or iodid. Cases which are not recognized in time, or which 
are neglected, may lead to very severe narrowing of the laryngeal space, and 
may make it necessary for the patient to constantly wear a tube in the throat. 

Tuberculosis of the Larynx.—This is a disease which is as frequent as it 
is dreaded. The larynx is rarely the first place at which tuberculosis mani¬ 
fests itself; and involvement of this organ is generally an accompanying 
symptom of a long-existing pulmonary tuberculosis. The affection occurs 
as a result of the transmission of the tuberculosis-bacillus through the blood- 
current; sometimes also by infection through bacillus-containing sputum 
which may remain in the larynx for some time. Tuberculosis of the larynx 
affects principally young adults. Advanced age is not exempt, however; and 
in very rare cases children may be attacked also. 

Obstinate hoarseness and, on longer duration, pain during swallowing 
and impairment of respiration are the manifestations of the disease. These 
are the results of infiltration in the vocal cords, the smooth borders of which 
appear corroded owing to tuberculous inflammation of the mucous mem¬ 
brane and cartilages of the larynx. The air-passage is sometimes obstructed 
by swellings to such an extent that an incision must be made into the wind¬ 
pipe in order to prevent suffocation. In rare cases tuberculosis of the 
larynx may manifest itself by the formation of a tumoi without ulceiation. 
If this be the case the tumor may be operated for like a polypus of the vocal 
cords. 

Tuberculosis of the larynx is usually a chronic disease which may last 
for years. Lack of proper treatment, bad air, early pains upon swallowing, 
insufficient nourishment, and a hereditary tendency to tuberculous afiections 
hasten the distressing termination of the malady. The progress of the dis¬ 
ease may often be retarded for years by an appropriate mode of h\ing, and 
by having the larynx treated by a specialist who will cauterize and scrape 
the affected parts. Complete cures are occasionally, though rarely, effected. 




Laudanum 

Legumes 


THE STANDARD FAMILY PHYSICIAN 


504 


Tumors of the Larynx.—Various morbid growths may form in the 
larynx, but those of most frequent occurrence are benign in character- 
Polypus of the vocal cords causes permanent hoarseness unaccompanied 
by pain or any other disturbances. Complete recovery takes place upon 
the operative removal of the growth, which a practised hand may accom¬ 
plish easily and painlessly through the mouth. Singers' nodules result 
from overexertion, or from the use of wrong methods in singing. Warts 
frequently appear, also in children. They cause permanent hoarseness, 
and often respiratory difficulties. Cancer is malignant, and can be removed 
by a surgical operation only when recognized in time. 

LAUDANUM .—See Opium. 

LAUGHTER, CONVULSIVE.— See Hysteria. 

LAVENDER.—The fresh leaves and tops of the Lavandula officinalis , 
an aromatic shrub of the mint family ( Labiatee ). The oil of lavender is 
used as a perfume, and as an adjuvant in various remedies and hand lotions. 
A few drops of the spirit are sometimes given with some simple bitter in 
cases of indigestion with flatulence. 

LEAD-POISONING.—Acute attacks of this form of poisoning some¬ 
times occur as the result of the swallowing of sugar of lead, or of white lead- 
pigment. As a rule, however, it comes on insidiously, and pursues a chronic 
course. This is met with in persons who are engaged in handling the metal, 
or employed in establishments where the various products derived from 
lead are manufactured. The list includes smelters, lead-pipe workers, 
type-founders, typesetters, potters and others who employ lead-glazes, art¬ 
ists, painters and lacquerers who make use of the various lead-pigments, 
and furriers, hatters, and dyers who use lead sulfate for dyeing purposes. 
Lead-poisoning may be brought about also by eating or drinking from ves¬ 
sels which are incompletely glazed, by using food which has been preserved 
in cans soldered with lead, by drinking water which has been standing in 
lead-pipes, by using tea or chocolate which has been packed in lead-foil, 
by working on clothes which have been dyed with lead-pigments, and by 
the application of hair-dyes and face-paints which contain lead. 

The acute form of lead-poisoning is marked by pains in the lower portion 
of the abdomen, nausea, vomiting, bloody stools or constipation, vertigo, 
and unconsciousness. This type often develops into the chronic form, the 
victims of which become emaciated and weak, with a pale, leaden com¬ 
plexion (Plate XIV., 6). The gums are spongy, and at the dental margin 
there may be seen a slate-gray line, the so-called “lead-line.” Among other 
symptoms, which may appear together or separately, may be mentioned 
severe colicky pains accompanied by obstinate constipation, nausea and 
vomiting, cutting pains in the limbs, temporary blindness, kidney-disease, 
paralysis (usually of the arms), delirium, and convulsions. 

It is only in the acute form of lead-poisoning that the laity can render 







505 


THE STANDARD FAMILY PHYSICIAN 


Laudanum 

Legumes 



Fig. 248. Manner of applying a leech. 


any assistance to the patient. This should consist in the production of free 
vomiting, and in the administration of milk and eggs beaten out in water, 
and of a solution of Glauber’s salt or Epsom salts (1 to 2 tablespoonfuls in a 
pint of water). For the chronic form of poisoning the physician must be 
consulted; but the patient should be immediately enjoined to give up the 
work which is the cause of the trouble. See also the article on Occupa¬ 
tion Diseases. 

LEECH.—A blood-sucking aquatic worm used in medicine for the pur¬ 
pose of abstracting blood through the skin. By means of its serrated jaws 
the leech attaches itself to the skin and sucks up about two or three times 
its own weight of blood. The part to which a leech is to be applied must 
be carefully cleansed with soap and water in order to guard against infec¬ 
tion. The best method of applying a 
leech is to place it in a narrow test- 
tube, the opening of which is thereupon 
pressed against the skin (see Fig. 248); 
and the animal may be induced to bite 
more rapidly if a drop of blood has been 
secured by first pricking the skin with a 
needle. As soon as the leech is fully 
distended, it lets go of its own accord. If it be desired to interrupt the ab¬ 
straction of blood before this time, a little salt water may be poured over the 
animal; this also rapidly kills it. The application of warm, moist poul¬ 
tices favors subsequent bleeding from the part to which the leech had been 
applied. In order to stop the bleeding at the point where the animal had 
bitten into the skin, a clean compress should be applied. 

LEGUMES.—The fruits of various members of the bean family, such 
as beans, peas, and lentils. Owing to the large amounts of proteids which 
they contain, legumes have often been called “poor man’s meat.” They 
play an important part as popular foodstuffs also on account of the large 
percentage of carbohydrates which they contain. By adding a sufficient 
quantity of fat and salt to a dish of legumes, it is quite possible to make it 
nourishing enough to fill all the requirements of the human body, using a 
daily consumption of about 18 ounces. It would require this quantity to 
make up for the loss of strength occurring in the daily work. This large 
amount, however, can not be readily utilized by the digestive organs. Even 
in the use of smaller amounts it is essential to remember that of the proteids 
of legumes twenty per cent, less are utilized than is the case with animal 
proteids; and even this amount of proteids can be utilized only when the 
legumes are properly prepared. This preparation includes the removal 
of the outer coats by sufficient boiling, and the transformation of the legumes 
into a pap. They are most readily digestible in the form of soups, because 
the digestive juices can then come in contact with the smallest particles and 





Lemon 

Lice 


THE STANDARD FAMILY PHYSICIAN 


506 


render them fit for absorption by the body. Some portions, however, al¬ 
ways remain undigested, even when cooked in the most appropriate manner. 
Nevertheless, the great importance of legumes as foodstuffs is not thereby 
lessened. Their low cost favors their extensive use; but it should be noted 
that it is better to eat them frequently in small quantities, than to eat them 
less often, but in large quantities. 

The legumes are thought to derive the nitrogen for the formation of their 
proteids directly from the air, through the agency of a variety of bacteria 
which causes the appearance of small bulbs on the roots. Hence soil which 
is otherwise unsuitable for legumes may be prepared by inoculation. 

LEMON. —See Limonis. 

LEPROSY. —A chronic, constitutional, and infectious disease. In the 
middle ages it was widely disseminated throughout Europe, but it occurs 
now only in a few European countries, especially in Sweden, Norway, the 
Baltic provinces of Russia, and in some of the southern countries. Several 
decades ago a small focus of leprosy appeared in the district of Memel, in 
Germany, the disease having been transmitted from the adjacent Courland. 
In Asia and Africa leprosy is a very wide-spread disease. It is almost un¬ 
known in the United States, but is present in the Hawaiian Islands. Lep¬ 
rosy is caused by a micro-organism which in its appearance and properties 
resembles the tubercle-bacillus. The bacillus leprce is contained especially 
in the secretions of the ulcers which develop in the skin of the patients, and 
may be transmitted by infection. Continued intercourse with leprous per¬ 
sons is quite as dangerous as the use of their household utensils or other 
objects to which the infectious substance may have adhered. Lack of 
proper care of the skin, personal uncleanliness, and unsanitary dwellings and 
garments, play a considerable part in the spread of the disease. 

Two chief forms of the disease are distinguished: tubercular leprosy and 
anesthetic leprosy. 

Tubercular leprosy is characterized by the development of tubercular 
nodes in the skin and mucous membranes; especially in the face, and on 
the knees, elbows, hands, and fingers. These growths, which in the be¬ 
ginning are hard, may gradually soften and break down into suppurating 
ulcers. The face of the patient is especially disfigured by these ulcerating 
growths. 

In the anesthetic type of leprosy the nerve-trunks are chiefly affected. 
In this form of the disease macular eruptions develop on the skin. These 
spots are at first reddish-white, later becoming darker, and are devoid of 
the sense of touch. This insensibility gradually extends over larger por¬ 
tions of the surface of the body, irrespective of the presence of the macu¬ 
lae. At the same time there occurs a wasting of the muscles (especially in 
the face, hands, and feet) which in consequence become paralyzed. The 
further course of the affection leads to the formation of ulcers. If situated 











507 


THE STANDARD FAMILY PHYSICIAN 


Lemon 

Lice 


upon the hands or feet, these ulcers may extend into the deeper layers, where 
their destructive process may lead to the loss of different joints of the fingers 
and toes; in rare cases also to considerable mutilations, such as the loss of 
an entire hand or foot. 

These two forms of leprosy can not be strictly differentiated. The 
symptoms of one frequently combine with those of the other, either in the 
later course of the disease, or from the very beginning. 

The course of leprosy is extremely protracted. It almost invariably 
causes a long-lasting illness, often persisting for decades, until death takes 
place in consequence of debility, or by supervening affections of vital internal 
organs. No positive remedy for leprosy is as yet known. The aims of the 
physician are therefore restricted to improvement of nutrition, alleviation 
of the pains, local treatment of the nodes and ulcers, etc. Some patients 
recover spontaneously. 

As leprosy is usually incurable, the main object should be its prevention. 
This is best accomplished by avoiding all contact with the leprous; and 
this, in turn, is most thoroughly achieved by the segregation and coloniza¬ 
tion of the patients in separate asylums, such as are being established in 
different countries throughout the world. The disappearance of leprosy 
from the greater part of Europe is due principally to the fact that the un¬ 
fortunate patients were treated with inexorable rigor during the middle 
ages. They were excluded from human society, expelled from the cities, and 
imprisoned in pest-houses. Naturally, modern hygienic and protective 
measures have advanced far beyond the cruel customs of medieval times. 
Coercion is used only for those patients who can not be sufficiently segre¬ 
gated in their own dwellings; and modern leprosy-houses are so organized 
that they are actual blessings to the patients who previously lived in filth, 
need, and misery. As a rule they exert also a favorable influence upon the 
course of the malady. In the early centuries it is probable that the term 
‘‘leprosy” included many other diseases, notably syphilis and tuberculosis. 

LEUCORRHEA. — See Vagina, Diseases of; Womb, Diseases of. 

LICE.—Wingless insects parasitic on man. They multiply rapidly, 
fasten themselves into the skin by biting, and suck the blood from the 
wound thus inflicted. Of the various species of lice, there are three chief 
kinds which infest human beings: the head-louse, the body-louse, and the 
crab-louse. 

The head-louse (see Fig. 249) is a six-legged insect about one-twelfth of 
an inch long, which lives in the hair of the head. Its eggs ( nits ), which 
are surrounded with a hard skin, are fastened to the hairs (see Fig. 250). 
The presence of lice in the scalp causes intense itching and scratching 
which gives rise to the formation of crusts and scabs, causing the hairs to 
become matted. If the scalp is greatly neglected, the eruption, which 
gives rise to glandular swellings in the nape of the neck, may spread to 





Lice 

Light 


THE STANDARD FAMILY PHYSICIAN 


508 


the face. Treatment consists in anointing and rubbing the head with a 
mixture of equal parts of kerosene and sweet-oil, followed, on the next day, 
by a thorough scrubbing and washing with soft soap. The nits are re¬ 
moved by continued combing with a fine comb immersed in vinegar. The 
eruption usually heals spontaneously after removal of the lice; if not, it 
must be treated by a physician. It is not necessary to have the hair cut. 

The body-louse (see Fig. 251) is a larger and quicker insect than the 
head-louse. It habitates only the body-linen, but it bites into and sucks 
the blood from the skin. Its traces, consisting in a very much scratched 



Fig. 251. Body-louse. Fig. 252. Crab-louse. 


skin, are found especially where the garments fit snugly; as at the belt, 
corset, suspenders, collar, etc. In persons who are greatly infested with 
lice, and who neglect this condition, the skin of the entire body often turns 
slate-colored to brown, and is interspersed with a number of scarred or 
bloody stripes, abscesses, and open ulcers. Treatment consists in disin¬ 
fecting the outer garments and the linen in separate apparatus, or in boiling 
them in water. 

The crab-louse (see Fig. 252) is a gray animal, broader than the head- 
louse, and lives almost exclusively in the hairs on the pubic region. In 
cases of extreme carelessness it may spread to the hairs of the other parts 
of the body (chest, armpits, beard, eyebrows, and eyelashes), but it never 






509 


THE STANDARD FAMILY PHYSICIAN 


Lice 

Light 


inhabits the hair of the head. It fastens itself so firmly to the skin at the 
roots of the hairs that it can be removed only with difficulty; and it appears 
like a blotch on the skin, the size of a pin-head or a millet-seed. The nits 
are surrounded with a hard covering and are firmly fastened to the hairs. 
Treatment is the same as for the head-louse,—rubbing with kerosene, and 
scrubbing with soft soap. Blue ointment, which is often used in these cases, 
may cause the occurrence of herpes. 

Lice are never the result of an internal affection or of a skin-disease; 
nor do they originate spontaneously in dirt. They are transmitted from one 
human being to another, and are indicative of dirty and careless habits. 

LICORICE.—See Glycyrrhiza. 

LIGHT.—It is an old and true saying that “where the sun does not enter, 
the physician does.” This demonstrates the importance of light to health. 
Light is a great stimulant to the skin, the effect of the sunlight shining upon 
the body being to increase its tone and stimulating its metabolism. Ex¬ 
cessive stimulation is possible, as in the tropics, and may lead to depression 
of the bodily vigor. Light also acts as a tonic to the red blood-corpuscles. 
The body’s requirement of oxygen, a main condition of life, is increased 
by the action of light. Human beings (such as prisoners) who live in dark¬ 
ness become pale and debilitated, and finally fall victims to wasting dis¬ 
eases, particularly to tuberculosis. Just as the plant obtains its green color 
only from the light, so does the healthy, red blood of man form only through 
the influence of the sunlight. Sunny, large, and airy dwellings are there¬ 
fore most important requirements. A large proportion of the population, 
particularly in the large cities, lives under unhealthy conditions, because 
of the darkness of the dwellings. Sunlight is a necessity to the healthy as 
well as to the sick. 

Children brought up in dark rooms develop a tendency to become anemic, 
and are stunted in their physical growth. Dark living-quarters exert a 
very depressing influence upon the mind, and consequently also upon the 
body. The eyes are strained and finally ruined. Lack of sufficient light 
renders it difficult to keep the rooms clean and orderly, and favors the 
growth of molds whose emanations poison the air. The bacteria which 
cause many of the contagious diseases retain their vitality for a much longer 
period in the dark; while an abundance of light (especially sunlight) destroys 
them very quickly. Dark apartments can rarely be satisfactorily aired 
because the windows are few; and the rooms consequently become damp. 
The artificial illumination rendered necessary by these conditions also aids 
in impoverishing the air of the rooms. 

The brightness of a room depends upon the proportion between window- 
space and floor-space. The windows ought to represent an area of from 
one-fifth to one-sixth of that of the floor. Another factor which determines 
the amount of light entering the room is the height of the windows. A 






Light 

Light-Bath 


THE STANDARD FAMILY PHYSICIAN 


510 


good test consists in observing how much of the sky remains within sight 
at various distances from the window. Narrow streets and courtyards 
render the lower stories dark, even if large and high windows are provided, 
for the houses on the opposite side cut off a large part of the light. Various 
remedies have been suggested for the purpose of overcoming this difficulty, 
among which may be mentioned whitewashing the opposite walls, the use 
of light-colored wall-papers, the application of light-reflecting devices in¬ 
side or outside the windows, and the installation of large mirrors in the 
rear of the rooms, facing the windows. Large trees cut off a good deal of 
light from the house, especially in summer. Heavy window-curtains had 
best be avoided, or else arranged in such a manner that the upper parts of 
the windows, through which the greatest amount of light enters, are left 
uncovered. For the purpose of tempering a strong light or the summer 
sun, grayish or yellowish window-shades made of cotton or linen may be 
employed. 

When selecting a dwelling, attention should always be given to the 
weather on the particular day when the inspection is being made; and the 
doors should be closed as under ordinary circumstances, so that a correct 
impression may be obtained as to the brightness of the rooms. The loca¬ 
tion of the rooms should also be considered. Rooms facing north do not 
receive any sunlight, and comparatively little daylight. Rooms facing 
south are most favorably situated, receiving strong sunlight during spring 
and fall, but only morning and late afternoon sun during the hot summer 
months. Rooms with western exposure are hot, but are better lighted 
than northerly rooms, provided of course that there are no walls or other 
objects to obstruct the light. The same may be said of rooms with eastern 
exposure. Writing-desks should be placed close to the windows so that 
they are lighted from in front or from the left-hand side. When the source 
of illumination is on the right side of the desk, the shadow of the writer’s 
hand is thrown on the paper. Daylight must be regarded as inadequate 
whenever it becomes necessary to bring ordinary print close to the eyes in 
order to decipher it, or when the eyes readily become tired. 

Artificial illumination can not displace daylight, and should be used only 
when necessary. A mixture of the two should be avoided as it affects the 
eyes. The requirements for artificial illumination are: cheapness, strength, 
a color resembling that of ordinary daylight, regularity, and softness. In 
addition to these the light must not vitiate the air of the room, nor overheat 
it. Some of these requirements are most completely met by the incandescent 
electric lamp with a frosted globe. Its use is, however, attended with con¬ 
siderable expense. Next to this in value comes the incandescent gas¬ 
light, in which a mantle of incombustible mineral material is brought to a 
white heat by the burning gas. Ordinary gas-burners, although they con¬ 
sume a greater quantity of gas, give less light and more heat, and also give 










511 


THE STANDARD FAMILY PHYSICIAN 


Light 

Light-Bath 


off a larger quantity of carbonic acid gas. Good kerosene-lamps give suffi¬ 
cient light for reading within a radius of three feet. The lamp-shade re¬ 
flects the light to the surface of the table, and protects the reader’s eyes 
against the direct rays. In the course of an hour an ordinary kerosene-lamp 
gives off about four times as much carbonic acid gas, and two and a half 
times as much heat, as a full-grown adult. The light of the spirit-lamp is 
similar in quality to that of the incandescent gas-flame, and may be safely 
recommended as used in the new types of lamps. Is is no more expensive 
than kerosene. Candles burn with too unsteady a flame, and give too 
little light for ordinary purposes. 

Kerosene as ordinarily marketed for illuminating purposes has very 
little tendency to catch fire. Explosions are usually due to the careless 
use of this fluid for lighting fires. Illuminating-gas is very poisonous; when 
inhaled it exerts an action similar to that of coal-gas, and is rapidly fatal. 
It explodes very readily when mixed with about ten parts of air. Rooms 
in which the presence of gas, is evident from its characteristic odor should 
never be entered with an open flame; but the windows should be opened 
as quickly as possible, the main service pipe shut off, and then the source 
of the escape sought for and remedied. 

LIGHT-BATH, ELECTRIC.—Distinction is to be made between two 
forms of electric-light baths,—that in which incandescent light is used, and 
that in which arc-lamps are employed. The latter serves principally for 
local radiation. Both forms of lamps are usually attached to the same ap¬ 
paratus, to be used ac¬ 
cording to choice. The 
apparatus used for the ap¬ 
plication of electric light 
is constructed in the form 
of a box, in which the 
patient either lies prone or 
sits in a chair (see Fig. 

253). The patient’s head 
remains outside the box, 
and the opening for the 
neck may be closed by the 
use of cloths. The inner 
walls of the box are cov¬ 
ered with mirrors, and are 
provided with rows of 
electric lights (40, 60, or 
more), some or all of 
which may be connected 

with the current as de- Fig. 253. Electric-light-bath apparatus (open). 


'$4tJ 















































Lightning- Stroke 
Lime 


THE STANDARD FAMILY PHYSICIAN 


512 


sired. A thermometer registers the temperature in the box, which usually 
should be about 113 0 F. Temperatures exceeding 140° F. should always 
be avoided. The duration of a bath should be from ten to twenty min¬ 
utes; rarely longer. By warming the box before the patient enters it, per¬ 
spiration will set in sooner. A cold compress to the head is advisable. 
As for the conditions best treated by these baths the advice of the family 
physician is needed. 

LIGHTNING STROKE.—Persons struck by lightning are usually killed 
instantly. In some cases there are no external evidences of injury on the 

victim’s body; in other instances there may be 
slight abrasions, singed hair, holes in the skin, 
small sloughs covered with scabs, and more or 
less extensive burns. Characteristic “light¬ 
ning marks” are seen quite often, and consist 
of branching striae, red or reddish-brown in 
color, which apparently indicate the path of the 
electric current (see Fig. 254). These marks 
usually disappear within a few days. Some 
victims of lightning strokes have been thrown 
bodily several yards, and severely injured by 
the fall. 

If the stricken person be not killed out¬ 
right, he is usually rendered unconscious and 
Branched markings on per- has a weak pulse, shallow respiration, cold 

son killed by lightning. . . i r '-m • r 

skm, and a pale face. Ihe prognosis for a 
complete cure is nevertheless favorable. After a longer or shorter period 
the injured person may recover from his coma without having been seri¬ 
ously injured; but as a rule partial paralysis, loss of speech, hyperesthesia 
or anesthesia of the skin, and various neurotic pains are the resultant dis¬ 
turbances. These, however, usually disappear under appropriate treatment. 

The first aid to a person injured by lightning should consist in loosening 
all tight garments, sprinkling the face with cold water, keeping the head low, 
rubbing the body, and applying smelling-salts to the nostrils. Enemas of 
vinegar or salt water should also be administered. If the person be able to 
swallow, a small quantity of an alcoholic stimulant, or Hoffmann’s ano¬ 
dyne, may be given on a lump of sugar or in a little water. When the acci¬ 
dent has taken place in a closed room, this should at once be thoroughly 
ventilated, or the patient brought into the open air. Other remedial meas¬ 
ures must be applied by the physician who should be called at the earliest 
opportunity. 

In order to avoid the danger of being struck by lightning, it is well to 
observe certain precautions. One should not cross an open field during a 
thunder-storm, nor seek shelter under tall, isolated trees. Telephone- and 



Fig. 254. 















513 


THE STANDARD FAMILY PHYSICIAN £jg^ tnin & stroke 

telegraph-poles should likewise be avoided. If caught in an open field, it is 
advisable to sit or lie down. In a room one should keep away from large 
metallic objects, such as chandeliers, and avoid using the telephone. Win¬ 
dows may be kept open, provided there is no draft. The greatest danger 
when a bolt of lightning finds its way into a closed room is that of suffoca¬ 
tion. The popular method of covering an injured person with clay, or 
burying him in earth, is a useless procedure. 

LIGHT-TREATMENT.—The treatment of disease by means of electric 
light was introduced by Nils Finsen, a Danish physician, who discovered that 
the ultraviolet rays cause redness 
and darkening of the skin, and 
are capable of destroying bacteria. 

Incandescent-light baths, used for 
the purpose of inducing sweating, 
do not belong in this category. 

Treatment by electric light has been 
most successful in lupus and in a 
few diseases of the skin. In car¬ 
rying on the treatment the light 
from an arc-lamp is focussed by 
means of a quartz-lens, being cooled 
by passing through water, and is 
then directed to the affected por¬ 
tion of the skin which has pre¬ 
viously been rendered bloodless. 

The healthy skin must be protec¬ 
ted from the light. If the treat- 

. Fig. 255. Electric lamp for light-treatment 

ment be continued long enough, 

the lupus nodes will disappear, leaving only a non-disfiguring scar. The 
method has recently been improved by the construction of special lamps 
in which the electrodes are made from iron instead of from coal, thus 
furnishing a very bright and cold light, with high bactericidal power. 
Applications with this lamp (see Fig. 255) require much less time. 

Red light has a certain action on the skin (seen, for instance, in erup¬ 
tive diseases, such as smallpox, measles, etc.), but has not yet been thor¬ 
oughly investigated. The entire system of light-treatment is still in its stage 
of development, but that has not prevented its being utilized by quacks. 
The application of this treatment by inexperienced laymen will not fail to 
result in injurious after-effects. The public should not allow itself to be 
entrapped by the advertisements of these non-professional “light-healers.” 
Fig. 256 shows the Finsen treatment with the utilization of sunlight. 

LIME, CHLORINATED (CALX CHLORATA).—A white, or grayish, 
granulated powder, with a strong penetrating odor, and a repulsive salty 
































Lime-Water 

Lips 


THE STANDARD FAMILY PHYSICIAN 


514 


taste. It is obtained by the action of chlorin on slaked lime, and is usually 
misnamed “chlorid of lime.” It contains about 35 per cent, of chlorin-gas, 
which is a very active germicide, and is extensively used as a destroyer of 
putrefactive bacteria. See Antiseptic. 

Chlorinated lime is employed also in medicine, both externally and in¬ 
ternally. Externally it has been used, in solution, as an application to 
putrid ulcers and skin eruptions, especially the itch. Internally it has 



Fig. 256. The Finsen treatment, with utilization of sunlight 


occasionally been employed in dysentery, typhus, etc., the dose for this 
purpose being from 2 to 5 grains, given in sweetened water. 

LIME-WATER (LIQUOR CALCIS).—A saturated watery solution of 
lime (calcium hydrate). It is a colorless and odorless liquid, having a 
salty taste. Lime-w r ater is used as an antacid in various gastric and intes¬ 
tinal disturbances which are accompanied with hyperacidity of the gastric 
juice; and it is an excellent remedy for nausea due to excessive irritation of 
the stomach. Externally, it is employed as a wash in certain eruptive skin 
diseases. Owing to its astringent properties, it is of use also in vaginal 
injections. The dose of lime-water is one or two wineglassfuls several times 
a day. Its long-continued use is not advisable. 

LIMONIS (LEMON).—The fruit of a tropical tree, Citrus limonum , of 
the orange family ( Aurantiacece ). It is from two to four inches in length, 
of a bright yellow color, and has a thick rind. The most important 


















515 


THE STANDARD FAMILY PHYSICIAN 


Lime-Water 

Lips 


constituent of the pulp is Citric Acid (which see), while the rind yields 
an oil which is largely used for flavoring purposes. 

LIMPING.—A halting gait may be due to various causes, and may be 
a symptom of more or less importance. It may be due to painful affections 
in the foot or in the leg; or it may be indicative of a difference in the length 
of the legs. After a fracture of a bone of the leg, for instance, the injured 
limb may heal with shortening, thus giving rise to a limping walk. The 
most important causes of limping are inflammations of joints, such as the 
hip-joint, the knee-joint, or the joints of the foot. An injury to a joint may 
likewise produce limping when the joint Loses some of its normal movability. 
In one-sided congenital dislocations of the Hip-Joint (which see), limping 
is present in consequence of the deformity. It may be caused also by 
paralysis of the muscles of the leg. Only a physician is able to determine 
the cause of the affection, and to give treatment accordingly. 

LINIMENTS.—Oily or soapy liquids which are used externally for rub¬ 
bing into a part. They may contain stimulating elements, like chloro¬ 
form or turpentine, which act as counter-irritants, or local anesthetics 
like belladonna or aconite; or they may contain principles which are 
absorbed and act on the body, such as the oil of wintergreem In most 
cases, however, the benefit derived is largely due to the massage which is 
administered in applying the liniment. Sprains and bruises, old fractures, 
muscular rheumatism, sciatica and lumbago are often greatly improved 
by the use of suitable liniments. There are innumerable formulas for 
such preparations, the basis for most of them being soap liniment. Some 
of the better known liniments contain chloroform, belladonna, camphor, 

and turpentine. 

LINSEED.—See Flaxseed. 

LIPS, CANCER OF.—Cancerous tumors develop comparatively often in 
men of advanced age. They usually appear on the lower lip—rarely on 
the upper one—and generally on parts which have been exposed to con¬ 
tinued pressure, as by a pipe. One of the first signs is the development of 
a small sore on the skin edge of the lip, at times resembling a fever-sore. 
This persists for years, gradually spreading and increasing in size. The 
center of the ulcer is depressed, whereas the edges aie considerably thick 
ened or swollen from inflammation (see big. 257)* The growth of the 
cancer is slow, but steadily progressive. In its more advanced stages it 
affects the lymph-glands of the lower jaw and of the thioat. The only 
successful treatment consists in the operative removal of the affected por¬ 
tions of the lip; but if the cancer has proliferated into the surrounding 
parts, and if the lymph-glands of throat and jaw have become swollen, the 
prospects of a permanent cure are not absolutely certain. Early treatment 
is, therefore, to be most urgently advised; and any obstinate “fever-sore” on 
the lips should be seen by a competent physician. 




Liquors 

Liver 


THE STANDARD FAMILY PHYSICIAN 


516 


LIQUORS .—A collective term for alcoholic beverages, such as whisky, 
brandy, gin, etc. Under this name may be included also the so-called 
“cordials” which form one of the favorite adjuncts of ladies’ coffee. Most 
women would resent the idea that these cordials are neither more nor less 
than alcoholic beverages; yet such is the case. They are merely distin¬ 
guished from other liquors by their spicy taste, and by the large amount of 
sugar which they contain. The celebrated products of the Carthusian and 
Benedictine monks may likewise be included in this category, although 
they are somewhat purer than the mixtures ordinarily marketed under the 



Fig. 257. Cancerous ulcer on the lower lip. 


designations of rose-cordials, vanilla-cordials, etc. Some cordials which 
are claimed to represent especially fine aromatic products are sold as 
“cremes.” 

Alcoholic beverages constitute one of the greatest enemies of mankind 
(see Alcoholism). If it be found necessary to employ liquor, a pure kind 
without any addition of sugar should be preferred. One of the best of 
these is cognac , which is prepared from grapes, and takes its name from a 
city in fiance. Brandies are prepared also from various fruits, such as 
cherries, blackberries, prunes, etc. Whisky is a liquor usually prepared 

fiom rye. Brandy made from potatoes may be counted as about the poorest 
alcoholic product in the market. 






517 


THE STANDARD FAMILY PHYSICIAN 


Liquors 

Liver 


Intoxicating liquors may be manufactured from almost any kind of grain 
or stone-fruit, as well as from potatoes, the taste of the product depending 
upon the material used in its manufacture. The true color of these prod¬ 
ucts is that of clear water, and the yellow tinge which they have when 
marketed is supposed to be derived from the wood of the casks in which 
they are stored until mature. Continued storage for several years is neces¬ 
sary for most brandies and whiskies, as by this means a “bouquet” is se¬ 
cured, some of the alcohol evaporates, and the product acquires a much 
milder taste. 

LISP.—See Speech Disturbances. 

LITHIUM.—A metallic, silvery-white element, of a consistency some¬ 
what softer than lead. Because of the fact that in the laboratory lithium 
shows a marked affinity for uric acid, it has acquired a reputation in gout 
and other disorders supposed to be due to an excess of uric acid in the sys¬ 
tem. It is often given freely in the hope of dissolving a stone in the blad¬ 
der. As a matter of fact it has no effect whatever, neither on stones nor 
on uric acid in the body. The good effects which follow its use are probably 
due to the large amount of water in which it is given; and it will probably be 
prescribed just as long as people will neglect to take the needed amount of 
water unless it contains some medicine. The citrate and carbonate are 
slightly diuretic, and are useful in rendering an irritating acid urine alkaline. 
Lithium bromid, benzoate, and salicylate act as do the other salts of those 
acids; but they are all irritating and may cause nausea and diarrhea. 

LIVER.—For structure and functions, see Introductory Chapters 

(p. 58). 

LIVER, DISEASES OF.—The liver is a very much abused organ. In 
the minds of most people the liver is always at fault; while as a matter of 
fact the liver is one of the most accommodating organs of the body. It is 
rarely sick, and usually made so only by gross disregard of the ordinary 
rules of hygiene. The greater number of troubles ascribed to the liver are 
more often due to gastro-intestinal disturbances which, by involving the 
excretory ducts of the liver, cause symptoms of disease in that organ. In 
many tropical countries, however, parasites often cause severe liver-diseases. 
Only the more common liver affections are discussed here. 

Abscess of the Liver.—This affection occurs very rarely in temperate 
countries, being more frequently met with in the tropics where it usually 
accompanies another disease. In exceptional cases an abscess of the liver 
may form as the direct result of an injury, such as a blow or a fall. The 
symptoms of liver abscess are very obscure, and in many cases its presence 
may not become evident until it causes perforation of the skin or inflamma¬ 
tion of adjacent organs in the chest or in the abdomen. Even the most ex¬ 
perienced physician is at times unable to recognize the disease. Treatment 
consists in operation at the earliest possible moment. 








THE STANDARD FAMILY PHYSICIAN 


Atrophy of the Liver.— The disease known as “acute yellow atrophy of 
the liver” is an affection which, by fatty degeneration, by disintegration, 
and by rapid atrophy of the liver-cells, quickly leads to a diminution in the 
size of the organ. The malady, which is very rare, principally affects 


Right lung 


Diaphragm 


Liver 


Stomach 









Ileum 


Suspensory 
ligament of liver 

Gall-bladder 


Transverse colon 


Ascending colon 


Left lung 


Heart 


Fig. 258. Diagram showing position of the liver in relation to other organs. 

pregnant women. It begins with jaundice and with disturbances of the 
stomach and intestine. After a longer or shorter interval the brain and 
nervous system become involved, giving rise to severe symptoms of delirium, 
convulsions, and periods of coma, which almost invariably lead to a fatal 
termination. It is one of the most feared complications of pregnancy. 






































519 THE STANDARD FAMILY PHYSICIAN Liver 

Acute yellow atrophy is a condition which results also from acute phos¬ 
phorus-poisoning, and to an analogous degree from arsenic-poisoning. 

Cancer of the Liver, T his affection occurs most frequently between 
the fortieth and sixtieth years of life. Heredity, climatic influences, in¬ 
juries, and gall-stones are thought to be among the causative factors of this 
condition, but the true origin of cancer is not yet known. Cancer of the 
liver usually occurs as a secondary disease following cancerous affections 
of other organs. It is often a very insidious disease, and may give rise to 
no symptoms until well advanced. There may be violent pains in the 
region of the liver, radiating into the small of the back or even into the arms, 
and jaundice usually develops. As a matter of fact, jaundice is one of the 
earliest symptoms, and a persistent attack of this affection should always 
be looked upon with suspicion, as being a possible indication of cancer of 
the liver. 

Patients afflicted with cancer of the liver become emaciated, and their 
skin becomes dry and thin, and assumes a grayish or pale yellow color. 
Many patients complain of persistent sleeplessness, constant itching of the 
skin, loss of appetite, great thirst, difficulty in swallowing, etc. The dis¬ 
ease is a very grave one, in which the physician is able only to alleviate the 
most annoying disturbances. Cancer of the liver is of very rare occurrence 
in tropical climates. 

Cirrhosis of the Liver.—A chronic inflammatory disease characterized 
by morbid formation of connective tissue with subsequent atrophy of the 
liver-cells. The most frequent, almost the only, cause of this affection is 
the excessive use of alcoholic drinks. The stronger the alcoholic drink 
imbibed, and the less solid food eaten with it, the more frequent is the oc¬ 
currence of this condition, which is essentially a drunkards’ disease. Since 
men are by far more often addicted to drink, the “alcoholic liver” is found 
more frequently in them than in women. It occasionally occurs in children. 

The course of the disease is a chronic one. Its first symptoms are 
usually concealed by those of a persistent catarrh of the stomach, or of 
the intestine. It is recognized with certainty principally when the liver 
shows changes in size. The liver is first enlarged, and then (as a rule) 
diminished in size. Abdominal dropsy occurring in the course of this dis¬ 
ease is usually one of the symptoms which cause the patient to consult a 
physician. Jaundice, but more often a sallow or pasty complexion, is a 
subsequent condition. Still later other symptoms set in; such as marked 
general emaciation, dropsy in the legs, and dilatation of the veins of the 
skin (blue veins), especially in the neighborhood of the navel. 

The essential part of the treatment is early abstinence from alcoholic 
drinks, which alone renders recovery possible, although not certain. Other¬ 
wise, death occurs either from general exhaustion, or in consequence of 
gastric or intestinal hemorrhages, paralysis of the heart, etc. Patients 






Liver 

Lobelia 


THE STANDARD FAMILY PHYSICIAN 


520 


usually consult a physician so late that it is possible only to alleviate or cure 
the more dangerous symptoms; this, however, is at least conducive to 

prolonging life. 

During the term of treatment the diet should consist of easily digestible, 
non-irritating foods, such as milk, eggs, soup, fish, lean meat, fruits, and 
easily digestible vegetables. The waters of certain medicinal spas (in 
Europe: Carlsbad, and Kissingen; in the United States: Hot Springs, Va., 
Saratoga Springs, N. Y., and Hot Springs, Ark.) are often beneficial to 
patients suffering with cirrhosis of the liver. In cases where the disease 
is so far advanced that it is hopeless, the physician can not always strictly 
prohibit the use of alcoholic stimulants. If abdominal dropsy be present, 
the water must be tapped from time to time by means of abdominal punc¬ 
ture. This affords great relief to the patients. Within recent years surgical 
operations have been devised, which have for their object the relief of ab¬ 
dominal dropsy in cirrhosis. The observations on their results have not 
yet been sufficient to justify any definite general conclusions. 

Echinococcus of the Liver.—The human liver may become infested 
with the larvae of the Ttenia echinococcus , a small tapeworm of the dog 
(see Fig. 259). These larvae occur in a compound state, as round cysts, or 



Fig. 259. Echinococcus of the dog (natural size below). 


brood-capsules, which may reach the size of a man’s head. If the tape¬ 
worm eggs discharged from a dog get into the human body, the latter may 
acquire the echinococcus. Hence the disease principally prevails where 
dogs are raised under uncleanly conditions. A person who caresses his 
dog, or allows it to lick his face, exposes himself to this danger. Dogs, as 
is well known, are in the habit of cleaning their anus by licking it, thus 
causing the eggs of the tapeworm to be deposited on the tongue. The 
disease is fortunately rare in the United States, although it is becoming 
more prevalent of late. 

The liver is the favorite seat of the echinococcus, and infection of this 
organ causes it to increase greatly in size. This in turn causes compression 
of the right lung, upward pressure upon the heart, and severe dyspnoea. 
The cysts sometimes perforate into adjacent parts of the body, such as the 
pericardium or the pleura. They may also empty into the lungs, and the 
contents be coughed up. If perforation take place into the stomach or 
into the intestine, the contents are vomited, or discharged with the stools. 

The only practical treatment for this disease is by operation. It is 
often difficult, however, to recognize the affection. It should be borne in 




















521 


TIIE STANDARD FAMILY PHYSICIAN 


.Liver 

Lobelia 


mind that prevention is easier than cure, and that proper precautions will 
generally suffice to eliminate the danger of infection. The echinococcus 
. of cows, sheep, and other animals, may be discharged with their excrements, 
and then be eaten by dogs. Strict cleanliness should, therefore, be observed 
by all those who come in contact with these animals. 

Fatty Degeneration of the Liver.—As a rule this disease is a result of 
errors in diet. It occurs in persons who eat too much starchy food and 
sugar, and who drink excessive quantities of alcoholic beverages, without 
taking sufficient muscular exercise. In addition to fatty degeneration of 
the liver, these patients show signs of general obesity. The disease may 
affect also those who are debilitated by loss of blood, and those who suffer 
from chronic diseases of the lungs. It occurs to a very marked degree in 
cases of poisoning with phosphorus, arsenic, etc. 

Fatty degeneration of the liver may be present without causing any 
symptoms; but as a rule the patients complain of a feeling of tension or of 
pain in the region of the liver, loss of appetite, eructation, vomiting, and 
inclination to diarrhea. The stools are sometimes very pale in color owing 
to their small contents of bile. The disease is not in itself fatal; but the 
resultant disturbances of digestion and of metabolism, in the presence of a 
serious acute affection, may hasten the unfavorable termination. 

Syphilis of the Liver.—The liver is a frequent seat of syphilitic infection. 
The disease runs a very protracted course, and bears a direct relation to the 
causative affection. Upon the cure or non-cure of the original malady de¬ 
pends the termination of the local condition. The symptoms may be like 
those of abscess of the liver, or of chronic cirrhosis. 

LIVER-FLUKE.—See Worms. 

LIVER-SPOTS.—Yellowish, brown, or black patches on the skin. They 
are generally rounded, moderately raised, and sharply defined from the 
surrounding skin. Liver-spots have nothing in common with the liver, 
other than a remote similarity of color. Sometimes congenital, they often 
develop in great numbers in consequence of pregnancy, and disappear 
spontaneously. They may arise also in the course of debilitating diseases, 
such as cancer, or tuberculosis. If the spots appear in large numbers and 
are of a bluish-black color, with severe general symptoms, they may repre¬ 
sent malignant tumors. Since the latter occasionally develop from simple 
spots, their removal by a slight and painless operation should not be neg¬ 
lected. Local treatment of the condition consists in touching the spots 
for several hours with a solution of corrosive sublimate. This is often fol¬ 
lowed by scaling off of the skin, leaving the parts colorless. The spots are 
apt to recur, however. 

LOBELIA.—The leaves and top of the Indian tobacco or Lobelia inflata, 
a common plant of the United States. The active principle is lobelin , an 
alkaloid of somewhat uncertain action. An overdose causes vomiting, 






Liocomotor Ataxia 
Lung-s 


THE STANDARD FAMILY PHYSICIAN 


522 


prostration with feeble pulse, cold and clammy skin, and perhaps convul¬ 
sions and death from respiratory failure. The only use for lobelia inter¬ 
nally is in asthma of a nervous origin; and it is not an entirely safe drug in 
that condition, although sometimes productive of good results. The in¬ 
fusion is sometimes used as an application in ivy-poisoning. The dose of 
the tincture is from ten to thirty drops. 

LOCOMOTOR ATAXIA. —The principal symptom of a wasting disease 
of the spinal cord. See Tabes Dorsalis. 

LUMBAGO. —Pain in the small of the back. This is not an independ¬ 
ent affection, but a symptom which may be due to a variety of diseases. It 
occurs in inflammatory diseases of bones, in tumor formation in the verte¬ 
bral bodies, in affections of the rectum (cancer), in diseases of the female 
sexual organs, in muscular rheumatism, in sciatica, at the onset of infec¬ 
tious diseases (very early and very violent in smallpox), in diseases of the 
nerves and of the spinal cord, and after injuries. This long list may serve 
as a warning against continued self-treatment with popular ointments and 
plasters. Pain in the small of the back is often believed to be nothing but 
rheumatic pain. But inasmuch as such a pain may be due to a malignant 
disease which is curable only by prompt treatment, it is necessary as early 
as possible to undergo an examination by a physician. In women lumbago 
is often due to abdominal affections. This condition can not be relieved 
by domestic remedies, but requires removal of the causative affection. If 
due to posterior displacement of the womb, for instance, the- disturbance 
will disappear as soon as that organ is replaced into its proper position. 

LUNACY. —See Imbecility; Insanity; Mental Diseases. 

LUNAR CAUSTIC. —See Nitrate of Silver. 

LUNGS. —For structure and functions see Introductory Chapters 
(PP- 51 - 53 )* i 

LUNGS, DISEASES OF. —The lungs being complex organs it is evident 
that they are subject to complex diseases. At least three structures of the 
lung should be considered: (1) the outer serous layer, the pleura; (2) 
the internal framework, the bronchi; and (3) the parenchyma of the lung 
itself, the breathing spaces. It rarely happens that any one part of the lung 
can be affected without some other structure being involved. Pneumonia, 
for instance, involves not only the parenchyma, but the bronchi and pleura 
as well. In pulmonary tuberculosis (consumption) all three structures are 
likewise involved. In pleurisy it is usual to have only the pleura diseased, 
although the parenchyma of the lung just beneath the pleura is probably 
also involved; and in bronchitis, which principally involves the bronchi, 
the adjacent lung-tissue is also somewhat affected. Only the more com¬ 
mon lung-troubles aie considered under this heading, other diseases of 
these organs being discussed under their alphabetical arrangement. See 
Bronchitis; Pleurisy; Tuberculosis of the Lungs. 








5 ~ 6 THE STANDARD FAMILY PHYSICIAN ^^(nnotor Ataxia 

Dropsy of the Lungs.— A condition of the lungs, in which the pulmonary 
tissue as well as the pulmonary vesicles are saturated with serum which comes 
from the blood. It is known also as pulmonary edema, or “filling up” of 
the lungs, and is always a serious secondary affection. It occurs as a tem¬ 
porary state in rare cases of heart-defects and chronic affections of the kid- 



Fig. 260. Diagram showing the lungs in relation to other organs. 


neys. Usually it is a sign of approaching death, and is due to defective 
circulation. 

The most characteristic symptom of this severe disturbance of the cir¬ 
culation of the blood is marked shortness of breath. Breathing is very 
rapid, very labored, and there is rattling in the chest. The skin and the 
visible mucous membranes are bluish in color, and the patients are usually 
forced to sit erect in bed and to exert all the auxiliary respiratory muscles in 
order to pump air enough into the lungs to keep them alive. The sputum, 
which is usually very profuse at the beginning of an attack, becomes ar¬ 
rested as soon as the respiratory muscles relax, and remains in the air- 
passages, thus still further increasing the danger of suffocation. If the 






















Lungs 


THE STANDARD FAMILY PHYSICIAN 


524 


body becomes excessively charged with carbonic acid gas, unconsciousness 
will set in from which the patient can not be aroused. As already stated, 
dropsy of the lungs is not a disease of itself, but a terminal stage of many 
severe affections. 

Emphysema of the Lungs.— An affection in which the pulmonary vesicles 
lose their natural elasticity, so that they become unable to contract on ex¬ 
piration, and as a result remain more or less permanently dilated. A mod¬ 
erate degree of this condition is often observed in elderly people as the natural 
consequence of the gradual weakening of the lung-tissues. Emphysema is 
found also in younger persons, without being attributable to any known in¬ 
jury. In these cases there is usually present a congenital weakness of the 
lung-tissue. As a rule, however, the affection can be traced to certain 
pernicious influences, among which overexertion is one of the most im¬ 
portant. Hence the disease is found most frequently in glass-blowers, 
among players of wind-instruments, in workmen who perform hard bodily 
work which causes acceleration of respiration and increase of air-pressure 
during expiration, and in athletes who run too much. Severe whooping- 
cough, persistent bronchial catarrhs, asthma, and certain heart-diseases 
may also cause the development of emphysema. 

The symptoms of emphysema are fairly well marked. If the distention 
be slight, only mild disturbances of respiration may be present, particularly 
if the patient keeps quiet. Cough, expectoration, and oppression of the 
chest become more marked after bodily exertion, or when a bronchial 
catarrh (which usually is present) becomes aggravated. Unfavorable 
weather increases the respiratory disturbances. As the disease progresses 
and the dilatations become more pronounced, the difficulty in breathing 
becomes more marked; and the patients are forced to make considerable 
exertion, especially to force the air out of the lungs. A further consequence 
of the obstruction to respiration is an impairment of the interchange of gases, 
and the resultant overcharge of the blood with carbon dioxid. This is 
manifested by a bluish discoloration of the skin and mucous membranes. 
In the further course of the disease the heart also becomes implicated. The 
right half of the heart, by performing an increased amount of labor, en¬ 
deavors to remove the congestion of the blood in the lungs, caused by de¬ 
struction of many of the finest pulmonary blood-vessels; and it therefore 
becomes dilated. If, at length, the power of the heart relaxes, the conges¬ 
tion in the veins of the body becomes greater, and watery extravasations 
occur under the skin and in the thoracic and abdominal cavities, directly 
endangering the life of the patient. 

It is often possible to recognize the affection from an inspection of the 
upper part of the body. The neck is usually short and thick; the muscles 
situated in front and on the sides of the throat (especially those that sup¬ 
port the head) are greatly strained and thickened; the veins of the throat 






















525 


THE STANDARD FAMILY PHYSICIAN 


Lungs 


are dilated and stand out distinctly as bluish cords; the thorax is com¬ 
paratively short, but conspicuously broad and deep (see Plate XVII. 3); 
inspiration is short and labored, and expiration prolonged. 

The duration of the disease, as well as the severity of the disturbances, 
are subject to great fluctuations, and depend essentially upon whether the 
patient is able to take proper care of himself, or whether he is compelled to 
constantly expose himself to further harmful influences. But even at best 
the prospects of complete recovery are only slight; and physician as well as 
patient must regard it as a great success if the progress of the disease can 
be arrested. All measures must be directed toward overcoming the condi¬ 
tions which are known to aggravate the affection. The patient should re¬ 
frain as much as possible from all kinds of bodily labor, as well as from 
dancing, singing, shouting, and the playing of wind-instruments. He 
should avoid overburdening his stomach, and see to it that the bowels are 
evacuated every day. If the patient’s financial condition permit it, he 
should live in a mild climate during the inclement seasons; this will also 
facilitate the improvement or cure of a bronchial catarrh which may be 
present. 

In the treatment of emphysema it is necessary, in addition to the em¬ 
ployment of remedies which act less upon the disease process than upon 
the various resultant disturbances, to consider all those measures which 
mechanically facilitate expiration and possibly improve also the expansi¬ 
bility of the pulmonary tissue. For instance, a friend of the patient, or the 
patient himself, should place both hands flat over the side of the chest and 
exert pressure during expiration. This measure must be repeated from 
five to ten minutes daily for several weeks. The so-called pneumatic treat¬ 
ment has found wide application in the struggle against emphysema. 
Special forms of apparatus are widely employed. If a catarrh of the finer 
ramifications of the bronchi be present, inhalation of compressed air, such 
as is employed in pneumatic cabinets, is advisable. 

Gangrene of the Lungs. —Putrefactive bacteria, which enter the lungs 
and remain there, cause portions of the pulmonary tissue to die and to de¬ 
compose. These bacteria occasionally reach the lungs through the blood- 
current, as, for instance, in puerperal fever and inflammation of bones. 
More often they are introduced through the air-passages, or they spread 
from putrid areas into adjacent parts. 

The most frequent causes of pulmonary gangrene are foreign bodies, 
especially food remnants, which may enter the lungs by getting into the 
windpipe instead of into the esophagus, or by suction. This entrance may 
occur during vomiting, particularly in patients who are unconscious or in¬ 
sane, or who suffer from paralysis of the muscles of swallowing. Gan¬ 
grene of the lungs sometimes results from other severe affections of these 
organs, such as pneumonia, or suppurative catarrh of the bronchi. 





Lung's 


THE STANDARD FAMILY PHYSICIAN 


526 


The disease is either chronic or subacute. Fever is almost invariably 
present. Most patients have cough, stitching pains in the sides, and short¬ 
ness of breath. But neither these signs nor an examination of the lungs 
are sufficient to determine with certainty the true nature of the affection. 
In most cases a positive diagnosis may be arrived at by a microscopical and 
general study of the sputum. The sputum is characterized by its repulsively 
pungent and putrid odor which rapidly permeates the air in the neighbor¬ 
hood of the patient, rendering it almost impossible to approach him. The 
same applies to the breath and to the cough. The sputum is rather profuse, 
and soon after being expectorated is separates into layers: an upper layer 
which is mucopurulent and covered with froth; a middle layer which is 
more watery; and a lower layer which is almost entirely purulent, smeary, 
and yellowish-green. The lower layer also contains smaller or larger mal¬ 
odorous plugs which are especially characteristic of pulmonary gangrene. 

When only a circumscribed gangrenous area (a patch of gangrene) is 
present, recovery is not impossible; but the disease is always a very pro¬ 
tracted one, lasting for months or years. The stronger and younger the 
patient, and the smaller the diseased area, the more hopeful the outlook. 

In order to prevent the disease, great care should be taken when feeding 
unconscious patients; and those who suffer from disturbances of swallow¬ 
ing should be carefully watched. If necessary, artificial feeding with a throat 
catheter should be resorted to. Children should be taught not to take 
foreign bodies into their mouths. They, as well as grown persons, should 
accustom themselves to eat slowly and without talking. The medical treat¬ 
ment includes a careful dietary and a judicious use of antiseptics, which only 
the physician can determine. 

Pneumonia.—Inflammation of the lungs; a disease which is character¬ 
ized by a comparatively regular course. It usually develops at a time when 
the patient is in the best of health, progresses very acutely to a crisis, and 
ends abruptly either in recovery or in death. The individual attacked is 
suddenly affected by a violent chill which is followed by a sudden rise in 
temperature. After a few hours the patient usually suffers from acute pains 
in the affected side of the chest; his face becomes flushed, and he develops a 
short, painful cough, superficial breathing, and a severe feeling of oppression. 
The sputum, owing to a slight admixture of blood, very soon gets a rusty ap¬ 
pearance. This bloody sputum is peculiar to many forms of inflammation 
of the lungs, and is not necessarily a bad prognostic sign. The lips often 
show an eruption of blisters. During the further course of the disease the 
shortness of breath and the oppressive sensation become worse, the cough 
grows more violent and painful, and if respiration is labored the face may 
become somewhat bluish. The patient seems to grow sicker and sicker 
until the crisis appears. This occurs between the fifth and the ninth day of 
the disease; usually on the fifth or seventh day. Then the fever suddenly 







527 


THE STANDARD FAMILY PHA'SICIAN 


Lungs 


subsides, and the patient is bathed in a profuse sweat (see Fig. 261). The 
respirations become deeper and more quiet, the cough loosens, the pains all 
disappear and the appetite returns. In short, the patient has with one bound, 
as it were, escaped death. Although the patient may feel comparatively 
well after the crisis, it is important for him to remember that the morbid 



Pig. 261. Fever-chart of a typical case of lobar pneumonia, showing crisis on sixth day. 


changes are still present in the lungs, and do not subside for several days. 
In rare cases the disease resolves itself, not suddenly by crisis , but gradu¬ 
ally by what is known as lysis. In most cases the seat of the affection is in 
the lower lobes of the lung, more often in the right lung than in the left. 
The inflammatory process, however, may involve also the apexes of the 
lungs; and migrating inflammations (that is, such as attack the various 
parts of the lungs in succession) also occur. 

Pneumonia attacks people of all ages; but affects more men than women. 
























































Lungs 

Lupus 


THE STANDARD FAMILY PHYSICIAN 


528 




It is more frequent during winter and spring than in summer and autumn; 
and it has occasionally occurred epidemically in some dwellings, towns, 
prisons, barracks, schools, convents, etc. The disease is largely due to a 
special form of bacteria,—the Pneumococcus of Weichselbaum; the 
Diplococcus pneumoniae of other authors. Colds, which formerly were held 
responsible for the disease, are now looked upon merely as occasional causes. 
By injuring the mucous membrane of the lungs they enable the bacteria 
to enter the tissues, there to begin their harmful activity. Contusions of 
the chest may also be regarded as occasional contributory causes. Instead 
of acquiring an immunity by one attack of pneumonia, the disease seems to 
show a tendency to recur. Some patients may have as many as four or 
five invasions. 

In the treatment of the disease the physician usually restricts himself 
to combating the particularly annoying disturbances. He endeavors to 
ameliorate the pain in the sides, to reduce the fever, to lessen the cough, to 
keep the conditions of excitement (delirium) within moderate bounds, and 
to further the loosening of the sputum. But his main attention is directed 
to the heart. The great danger in pneumonia does not come from the lung 
involvement, but from the heart. If this organ grows weak and threatens 
to relax, it must be relieved by proper means, and must be stimulated to a 
more vigorous activity so that the patient may be able to stand the crisis. 
This careful watching of the heart is one of the most important tasks of 
the physician, because his timely interference in case of threatening danger 
may save many patients who otherwise would have succumbed. Such a 
responsible task, however, requires an exhaustive knowledge of the dis¬ 
ease, of its course, and of the methods of examination; and this is possessed 
only by a physician. 

Until the fever subsides the diet should consist of plain, pure water or 
mineral water, bland soups, and milk which may be stirred with the yolk 
of an egg or prepared with easily digestible flours. Preserved fruits, stewed 
apples, oranges, etc., are also permissible. The prescription of alcoholic 
stimulants is essential for habitual drinkers, but unnecessary in many other 
cases. The sick-room must not be too dark, and should be frequently ven¬ 
tilated. Pure, fresh air is of great importance. The fear that ventilation 
exposes the patient to the danger of catching cold is without foundation. 
Draft or cold air can become harmful only when the fever has receded and 
recovery begun. Warmer covers and the placing of a screen in front of the 
bed during the airing of the room will then afford sufficient protection. 
The sputum should be caught in a glass receptacle filled with a disinfecting 
solution. 

The peculiar course of pneumonia suggests some important practical 
explanations. It occasionally happens that it is not the nature of the dis¬ 
ease nor the constitution of the patient that is held responsible for the steady 








529 


THE STANDARD FAMILY PHYSICIAN 


Lungs 

Lupus 


progress of the affection until the crisis sets in, but the physician. The 
doctor s inability to check the disease arouses unjust criticism, especially 
in families whose members are disturbed by the agitations of opponents 
of “old school medicine.” And it often happens that during the worst 
period of the disease (shortly before the crisis) the regular attendant is dis 
missed, and another called, possibly a “natural healer.” If the crisis has 
taken place in the meanwhile, the newcomer has the satisfaction of having 
the patient appear as if he were transformed, and free from all danger. The 
members of the family ascribe this result to the “immediately successful” 
treatment of the new helper, without considering that the favorable turn had 
been due to the previous treatment during the anxious and important days 
preceding the crisis. They thus greatly wrong the physician whose careful 
supervision and treatment, although unable to check the progress of the 
disease, enabled the patient to overcome the crisis. The layman should, 
therefore, beware of erroneous and hasty conclusions. 

If the course of the disease be unfavorable, it leads rapidly to a fatal 
termination. In rare cases suppuration, gangrene, or shrinking of the 
lungs may supervene. Since a healthy heart is of great importance in the 
battle with pneumonia, it follows that drunkards, persons with weak hearts, 
the obese, and the aged are in great danger. 

In addition to the classical type of pneumonia, other forms develop in 
the course of certain diseases, such as typhoid fever, influenza, etc. There is, 
moreover, a so-called catarrhal variety of pneumonia, which occurs most 
frequently in children and in the aged, in connection with bronchitis (in 
measles, whooping-cough, smallpox, and diphtheria). This type, which 
is called bronchopneumonia, does not run as regular a course as ordinary 
pneumonia. It is of longer duration, lasting several weeks or months, and 
it does not improve suddenly but gradually. The sputum, which is usually 
absent in cases of small children, is never admixed with blood. Treat¬ 
ment consists in warm baths with cool to cold affusions, chest-packs, med¬ 
icines, and proper food. Bronchopneumonia is a very serious affection in 
small children 

LUPUS.—A form of tuberculosis of the skin and of the mucous mem¬ 
branes; called also “herpes exedens.” It is possible that the tubercle- 
bacillus colonizes in these patients because they possess a certain power 
of resistance to its general poisonous action. Lupus is a disease of youth, 
and is extremely persistent. Its onset is manifested by the appearance of 
small grayish-red nodules which slowly disintegrate, forming a superficial 
ulcer which gradually becomes covered with a scar, while new nodules and 
new ulcers appear at the margin in the healthy skin. The favorite seats of 
lupus are the sides and back of the nose, and the lips, and cheeks. It may, 
however, occur on all parts of the face; rarely in the pharynx and larynx. 
The affection, which is painless, is sometimes arrested spontaneously, to 







Lymphadenitis 

Lysol 


THE STANDARD FAMILY PHYSICIAN 


530 


flare up after a long interval. Injections of tuberculin may cause such a 
flaring up within a few days. 

Lupus of the mucous membrane of the nose may occur without affec¬ 
tion of the external nose. It appears especially in the conchse of the nose, 
where it occurs in the form of small nodules which readily bleed when 
touched, are covered with crusts, and disintegrate into ulcers. Lupus is 
treated as is tuberculosis. The affected parts of the mucous membrane are 
scraped and cauterized. Lupus of the skin is now treated successfully and 
without disfigurement by the Finsen method (see Light-Treatment), and 
with Roentgen rays. 

LYMPHADENITIS.—Inflammation of a lymphatic gland. These glands 
are everywhere inserted in the lymph-channels, and may become affected 
by poisonous substances carried into them through the lymph-vessels from 
an inflamed area. When this takes place an inflammatory reaction is set up 
in the glands, which causes the latter to swell and to become very sensitive 
to pressure. The glands may then be felt as coarse lumps under the skin; 
as in the armpit, under the jaw, on the neck, or in the groin. If the glands 
suppurate, the skin becomes red and inflamed. See Bubo. 

Persistent inflammation of the lymph-glands (such as may be observed 
in scrofula, tuberculosis, and in venereal diseases) likewise cause swellings, 
but as a rule these are painless and unaccompanied with fever. The swell¬ 
ings usually recede when the general condition improves. 

LYMPHANGEITIS.—Inflammation of the lymph-vessels. These vessels 
have the functions of absorbing the juice (the lymph) which permeates all 
the tissues of the body, and to carry it back to the blood-current (see pp. 
17-18.) When an inflammatory process takes place in any part of the body 
the lymph-vessels may, therefore, receive and carry along poisonous sub¬ 
stances which will cause them to become inflamed. Such inflammation of 
lymph-vessels becomes manifest by the appearance of reddish streaks in 
the skin, extending along the course of a lymphatic channel. They appear 
most frequently on the arms, extending from hand to armpit. Inflamma¬ 
tion of lymph-vessels is usually accompanied by pain and fever, and is an 
important sign that the inflammatory process is spreading from the original 
area. It therefore requires prompt and careful treatment (see Inflamma¬ 
tion). Blood-poisoning spreads through the lymph-vessels; and a knowl¬ 
edge of the lymphatic system is, therefore, of great service to physicians. 

LYSOL.—A powerful antiseptic and germicidal liquid, consisting of a 
fatty solution of tar-oil, subsequently saponified with the addition of alco¬ 
hol. It is a clear, brown, oil-like liquid, with an odor resembling that of 
creosote. Lysol is generally used in weak solutions (J to 1 per cent.) as an 
antiseptic wash; and although it is a more powerful germicide than corrosive 
sublimate, carbolic acid, etc., it is said to be less poisonous and irritating 
when applied to ulcerated areas. 






GUIDE TO MANIKIN 

I.—Internal Organs of Chest and Abdomen 


1. First rib 

2. Last rib 

3. Ensifoim cartilage 

4. Breast-bone 

5. Collar-bone 

6. Intercostal muscle 

7. Uppe* lobes of lungs 

8. Middle lobe of right lung 

9. Lower lobes of lungs 

10. Pericardial sac 

11. Trachea (windpipe) 


12. Liver 

13. Pyloric end of stomach 

14. Stomach 

15. . Ileum 

16. Ascending colon 

17. Transverse colon 

18. Descending colon 

19. Bladder 

20. Abdominal wall thrown back 

21. Abdominal veins exposed 


II. —Muscular System 


22. Frontal bone 

23. Trachea (windpipe) 

24. Collar-bone 

25. Tendon of biceps 

26. Frontal muscle 

27 Orbicularis palpebrarum (ring-muscle of 
the orbit) 

Orbicularis oris (ring-muscle of the mouth ; 
draws the lips together, pouts them, 
and presses them against the teeth) 

29. Zygomatic muscles 

30. Platysma myoides (superficial muscle of 

the neck) 

31. Sterno^Iidomastoid (bends the head for¬ 

ward) 

32. Pectoralis major (great muscle of the chest) 

33. Pectoralis minor (lesser muscle of the 

chest) 

34. Subclavius (passes from the shoulder- 

blade to the first rib) 

35. Serratus magnus (arises from the upper 

eight ribs and is inserted into the 
shoulder-blade) 

36. External oblique muscle of abdomen 

37. Linea alba (white seam of fascia separa¬ 

ting the abdominal muscles) 

38. Rectus abdominis (straight muscle of ab¬ 

domen) 

39. Internal oblique muscle of abdomen 

40. Poupart’s ligament 


41. Inguinal canal 

42. Iliopsoas 

43. Deltoid muscle (elevator of the arm) 

44. Coracobrachialis (raises the arm and draws 

it forward and inward) 

45. Biceps brachii (bends the arm) 

46. Brachial artery 

47. Inner head of the triceps 

48. Pronator radii teres (turns the hand and 

forearm and assists in bending the arm) 

49. Supinator longus (turns the palm of the 

hand outward) 

50. Flexor carpi radialis (bends the wrist and 

assists in turning the hand) 

51. Palmaris longus (stretches the inner tissue 

of the palm) 

52. Flexor carpi ulnaris (bends the wrist) 

53. Annular ligament of the wrist 

54. Abductor of the thumb 

55. Abductor of the little finger 

56. Flexor profundis digitorum (deep flexor of 

the fingers) 

57. } Long and short extensor muscles of the 

58. f thumb 

59. Extensor of the index-finger 

60. Patella (kneecap) 

61. Tibia 

62. Gluteus medius (abducts and rotates the 

thigh, and assists in keeping the body 
erect) 


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63. 


64. 

65. 

66 . 

67. 

68 . 


69. 

70. 


71. 


1 . 

2 . 

3. 

4. 

5. 


6 . 

7 

8 

9 . 

10 . 

11 . 

12 . 

13. 

14. 

15. 

16 . 

17. 

18. 

19. 

20 . 
21 . 
22 . 
23. 


24. 


25. 

26. 


1 . 

2 . 


Tensor tascias latas (tensor muscle of the 
fibrous tissue investing the muscles of 
the thigh) 

Iliopsoas (flexor of the hip) 

Iliacus 

Pectineus (abducts the leg and assists in 
bending it) 

Abductor longus (long abductor of the 
thigh) 

Rectus femoris(this muscle, together with 
the Vastus externus and V. internus, 
form the Quadriceps extensor cruris, 
the extensor of the knee, and the lar¬ 
gest muscle in the body) 

Patella (kneecap) 

Ligament of the kneecap 
Vastus internus (see No. 68) 


72. Vastus externus (see No. 68) 

73. Sartorius (tailor-muscle; functionates 

when one crosses the legs) 

74. Gracilis (abductor of thigh) 

75. Part of abductor*magnus. 

76. Tibialis anticus (flexor of the ankle) 

77. Extensor longus digitorum (long extensor 

of the toes) 

78. Peroneus brevis ) (strengthen the arch of 

79. Peroneus longus ( the foot) 

80. Gastrocnemius (the “calf” of the leg; 

bends the knee and extends the ankle- 
joint) 

81. Soleus (assists in extending the foot) 

82. Long extensor of the great toe 

83. Short extensor of the toes 


III. —Circulatory System 


Left ventricle of heart 
Right ventricle of heart 

auricle 

Left auricle 

Ascending aorta 

Arch of aorta 

Abdominal aorta 

Pulmonary artery 

Superior vena cava 

Inferior vena cava 

Innominate artery 

Right common carotid artery 

External maxillary artery 

Superficial temporal artery 

External jugular vein 

Subclavian artery 

Axillary artery 

Brachial artery 

Radial artery 

Ulnar artery 

Interrosseus arteries 

Diaphragmatic artery 

Celiac artery 

Renal artery 

Internal spermatic artery 


27. Inferior mesenteric artery 

28. Common iliac artery 

29. External iliac artery 

30. Circumflex artery 

31. Internal iliac artery 

32. Femoral artery 

33. Anterior tibial artery 

34. Recurrent anterior tibial artery 

35. Dorsal artery of the foot 

36. Metatarsal arteries 

37. Internal malleolar artery 

38. Innominate veins 

39. Internal jugular vein 

40. External jugular vein 

41. Subclavian vein 

42. Axillary vein 

43. Radial veins 

44. Basilic veins 

45. Median basilic vein 

46. Hepatic veins 

47. Renal veins 

48. Internal spermatic vein 

49. Common iliac vein 

50. Hypogastric vein 

51. External iliac vein 



IV—Nervous System 

Supraorbital nerve 3. Facial nerve 

Infraorbital nerve 4. Maxillary nerve 


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5. Spinal cord 1 (cervical region) 

6. Spinal cord (dorsal region) 

7. Spinal cor'd (lumbar region) 

8. Spinal cord (sacral region) 

9. Cauda equina 

1^' | Spinal serves 

12. Cervical plexus 

13. Brachial plexus 

14. Iliohypogastric nerves 

15. Intercostal nerves 

16. Ilio-ipguinal nerves 

17. Lumbosacral nerves 

|g‘ | Sacral plexus 

20. Last dorsal nerve 

21. Gsnitocrural nerve 

22. External cutaneous nerve 

V.— Skeleton ; 


23. Pudendal nerve 

24. Sympathetic chain 

25. Sciatic nerve 

27 . ( Cutaneous branches of anterior femoral 
PQ ( nerve 

29. Superficial peroneal nerve 

30. Median dorsal nerve 

31. External popliteal nerve 

32. Anterior tibial nerve 

33. Musculocutaneous nerves 

34. Median nerve 

35. Musculocutaneous nerves 

36. Superacromial nerve 

37. Circumflex nerve 

38. Superficial branches of internal cutaneous 

nerves 

39. Ulnar nerve 
Internal Organs 


1. ’Yontal bone 

30. 

Radius f bones of forearm 

2. Parietal bone 

31. 

3. Temporal bone 

32. 

Bones of wrist 

4. Orbit 

33. 

Metacarpal bones 

5. Nasal bone 

34. 

Fingers 

(: Superior maxillary bone (upper jaw) 

35- 

Breast- bone 

' Inferior maxillary bone (lower jaw) 

36. 

Manubrium of breast-bone 

-. Internal surface of skull 

37. 

Ensiform process of breast-bone 

). Dura mater 

38. 

Costal cartilage 

0. Pia mater 

39. 

Iliac fossae 

11. Convolutions of brain 

40. 

Ischium 

12- White matter (fibers) of brain 

41. 

Ilium 

13. Blood-vessels (arteries) of brain 

42. 

Obturator foramen 

14. Mastoid process 

43. 

Pubis 

15. Seventh cervical vertebra 

44. 

Body of femur (thigh-bone) 

16. First dorsal vertebra 

45 

Head of femur 

17. Twelfth dorsal vertebra 

46 

Neck of femur 

18. First lumbar vertebra 

47 

Greater trochanter of femur 

19. Fifth lumbar vertebra 

48. 

Lesser trochanter of femur 

20. Sacrum 

49. 

External tuberosity of femur 

21. Transverse process of vertebra 

50. 

Internal tuberosity of femur 

22. First true rib 

51. 

52. 

53. 

Fibula } bones of le S 

Internal malleolus (tibia) 

23. Seventh true rib 

24. False ribs 

25. Intercostal muscles 

54. 

External malleolus (fibula) 

26. Clavicle (collar-bone) 

55. 

Bones of the heel 

27. Scapula (shoulder-blade) 

56. 

Metatarsal bones 

28. Humerus 

57. 

Toes 

29. Condyle of humerus 

58. 

Larynx 


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59. Thyroid gland 

82. 

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Csecum 

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Ascending colon 

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88. 

Transverse colon 

vessels and bronchial ramifications 

89. 

Descending colon 

66. Heart 'open) 

90. 

Sigmoid flexure 

67. Left ventricle 

91. 

Rectum 

68. Rignt ventricle 

92. 

Diaphragm 

69. Right auricle 

93. 

Liver (external surface) 

70. Ascending aorta 

94. 

Liver (internal surface) 

71. Pulmonary artery 

95. 

Liver (posterior aspect) 

72. Superior vena cava 

96. 

Gall-bladder 

73. Posterior aspect of heart 

97. 

Right kidney 

74. Pulmonary vein 

98. 

Left kidney 

75. Inferior vena cava 

99. 

Left ureter 

76. nterior aspect of esophagus 

77. Esophagus 

100. 

Right ureter 

78. Stomach 

101. 

Bladder (external surface) 

79. Interior aspect of stomach 

102. 

Bladder (posterior aspect) 

80. Cardiac orifice 

103. 

Bladder (internal surface) 

81. Pylorus 

104. Urethra 




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